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Case Number: 2007-1550-F FOIA MARKER This is not a textual record. This is used as an administrative marker by the Clinton Presidential Library Staff. Folder Title: Dempsey-AIDS [1] Staff Office-Individual: African Affairs-Byrne, Cathy/Dempsey, Nora/Battenfield, Patricia Original OA/ID Number: 3078 Row: Section: Shelf: Position: Stack: 29 4 3 2 V Withdrawal/Redaction Sheet Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001a. fax Fax coversheet from Kenneth Bernard to Frank Loy, et al. [partial] [10 05/02/2000 P3/b(3) U.S.C. 424] (1 page) 001b. memo Kenneth Bernard and Sandra Thurman to Leon Fuerth, et al., re: P3/b(3) Interagency Working Group on the Global AIDS Crisis [partial] [10 U.S.C. 424] (0 page) 001c paper Interagency Working Group Consensus Paper (13 pages) 04/28/2000 P1/b(1) KBH 10/21/2024 002 memo Kenneth Bernard to Secretary Shalala and Sandra Thurman, re: French 06/02/2000 P1/b(1) KBH 10/21/2024 Proposal for a Conference on Access to HIV/AIDS Drugs (3 pages) 003. letter Terje Anderson to Henry DuToit [partial] (1 page) ca. 05/2000 P6/b(6) COLLECTION: Clinton Presidential Records National Security Council African Affairs (Byrne, Cathy/Dempsey, Nora/Battenfield, Patricia) OA/Box Number: [OA/ID 3078] FOLDER TITLE: Dempsey - AIDS [1] 2007-1550-F ke2005 RESTRICTION CODES Presidential Records Act - [44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. Byrne, Catherine E. (AF) From: WHSR Sent: Tuesday, November 28, 2000 6:04 AM To: Babbitt, James F. (VP); Bernard, Kenneth W. (HEALTH); Byrne, Catherine E. (AF); Efros, Laura L. (NEC); Harris, Grant T. (AF); Smith, Gayle E. (AF) Subject: FACTS AND FIGURES ABOUT AIDS IN AFRICA Classification: UNCLASSIFIED Distribution: SIT: BABBITT BERNARD BYRNE EFROS HARRISG SMITH Identifier: R239eab0 Originator: Reuters Precedence: RUSH TimeOfReceipt: 11/28/2000 07:03:38 ET a1122 ^BC-HEALTH-AIDS-AFRICA-FACTBOX (EMBARGOED) ^Facts and figures about AIDS in Africa (Release at 1300 GMT Nov 28) NAIROBI, Nov 28 (Reuters) - The following are some facts and figures about the AIDS epidemic in Africa as issued by the United Nations ahead of World AIDS day on December 1. - The total number of Africans living with HIV or AIDS is now 25.3 million out of 36.1 million cases worldwide. Africa is home to 70 percent of adults and 80 percent of children living with HIV. - More than 15 million Africans have died of AIDS-related diseases out of 20 million global deaths. - There are 12 women living with HIV for every 10 infected men in Africa. African women in their early twenties are three times more likely to be infected than men. - Public health spending on AIDS exceeds two percent of gross domestic product in Africa. In South Africa, GDP is expected to be 17 percent lower in 2010 than it would have been without AIDS and wipe $22 billion from the economy. - In Botswana, some 35.8 percent of adults are infected with HIV and the rate has more than tripled since 1992. - In Zimbabwe, life expectancy has shrunk from 66 years to 43 as a result of AIDS. - More than one in four Zambians living in urban areas is HIV positive. - Over 70 percent of hospital beds in Burundi are taken by AIDS patients. RB-- 11/28/00 07:01:47 1 Cooper, Colby J. (AF) From: Efros, Laura L. (NEC) Sent: Tuesday, November 21, 2000 7:16 PM To: Bradtke, Robert A. (EXSEC); Smith, Gayle E. (AF); Samans, Richard (INTECON) Cc: @AFRICA - African Affairs Subject: Religious leaders list for World AIDS Day event [UNCLASSIFIED] I'm forwarding you Sandy Thurman's list of religious leaders for the World AIDS Day event on the unclass system. They are mostly Africans, but let me know if you would like me to send it around to other regional directorates, multilat, etc. My understanding from Loretta's meeting is that only the South African archbishop would have a speaking role during the POTUS event, and that the others would only interact with the President if there's some kind of receiving line. The entire group would also participate in a religious leaders conference on AIDS at USAID and an inter-denominational service led by Andy Young. 1 A CONSENSUS FROM CONSCIENCE: REVEALING THE ROLE OF FAITH IN RESPONSE TO AIDS White House World AIDS Day Summit 2000 November 30 - December 1, 2000 Speakers and Domestic Invitees List 1. Speakers Stephen L. Carter, J.D. William Nelson Cromwell Professor of Law Yale University New Haven, CT 06520 Tel: 203-432-4830 Fax: 203-243-4871 Ambassador Andrew Young GoodWorks International, LLC 303 Peachtree St NE Suite 4420 Atlanta, GA 30308 USA telephone: 404.524.5700 fax: 404.527.3827 Elie Wiesel The Elie Wiesel Foundation for Humanity 380 Madison Avenue, 20th Floor New York, NY 10017 Telephone: 212.490.7777 Fax: 212.490.6006 Margaret Ann Farley Stark Prof of Christian Ethics Yale Divinity School SDQ/Porter 329 New Haven, CT 06520 [email protected] Tel: 203-432-5355 Fax: 203-432-5356 William H. Foege, M.D., M.P.H. Rollins School of Public Health 1518 Clifton Road, NE Atlanta, GA 30322 Tel: 404-727-1038 Fax: 404-727-8436 2. US Denominational and Other Religious Leaders Rabbi Joseph Edelheit Temple Israel 2324 Emerson Avenue, South Minneapolis, MN 55405 Tel: 612-377-8680 Fax: 612-377-6630 The Reverend Jesse Jackson Rainbow/PUSH Coalition 208 S. LaSalle Street Suite 1277 Chicago, IL 60604 Tel: 773-373-3366 Fax: 773-373-3571 Fax: 202-728-1192 (Lydia Watts) Mrs. Coretta Scott King Founder The King Center 449 Auburn Avenue Atlanta, GA 30312 Tel: 404-526-8900 Fax: 404-524-7245 The Reverend Dr. Robert Franklin President Interdenominational Theological Center 700 Martin Luther King, Jr. Drive, SW Atlanta, GA 30314-4143 Tel: 404-527-7702 Fax: 404-527-7770 The Reverend Dr. Leon Sullivan Chairman Peoples Investment Fund for Africa 5040 East Shea Blvd. Phoenix, AZ 85254-4610 Ph: 602-443-1800 Fax: 602-443-1824 The Most Reverend Frank Tracy Griswold Presiding Bishop and Primate The Episcopal Church, USA Episcopal Church Center 815 Second Avenue New York, NY 10017 Ph: 212 867-8400 Fax: 212-490-3298 The Right Reverend H. George Allen Presiding Bishop Evangelical Lutheran Church in America 8765 W. Higgins Road Chicago, IL 60631 Ph: 1-800-638-3522 Fax: 773-380-1465 The Reverend Clifton Kirkpatrick Stated Clerk Presbyterian Church USA 100 Witherspoon Street Louisville, KY 40202 Ph: 502-569-5000 Fax: 502-569-5018 Sullivan Robinson The Congress of National Black Churches 1225 Eye Street, N.W., Suite 750 Washington, DC 20005 Ph: (202) 371-1091 Fax: 202-371-0908 Bishop Felton E. May Superintendent Washington Baltimore Conference United Methodist Church 9720 Patuxent Woods Drive, Suite 100 Columbia, MD 21046 Ph: 410-309-3400 Fax: 410-309-9436 The Reverend Richard Cizik National Association for Evangelicals Office for Governmental Affairs 1001 Connecticut Avenue, NW, Suite 522 Washington, DC 20036 Ph: 202-789-1011 Fax: 202-842-0392 The Reverend William Shaw National Baptist Convention Fax: 215-474-3332 The Right Reverend Vashti McKenzie Presidng Prelate, 18th Episcopal District African Methodist Episcopal Church South Africa Ph: 266-310-548 Fax: 266-320-869 Also Fax Ms. Travis:410-869-9160 The Reverend Dr. Rebecca Parker President Starrting School for the Ministry 2441 Le Conte Avenue Berkeley, CA 94709 Ph: 510-845-6232 Fax: 510-845-6273 The Reverend Altagracia Perez, S.T.M. Church of Saint Phillip the Evangelist 2800 Stanford Avenue Los Angeles, CA 90011 Ph: 323-232-3494 Fax: 323-232-0018 The Reverend Joseph Hough President Union Theological Seminary 3041 Broadway at 121st Street New York, NY 10027 Ph: 212-662-7100 Fax: 212-280-1416 The Reverend Chandler Owens The Reverend Canon Ted Karpf Episcopal Diocese of Washington Episcopal Church House Mount St. Alban Washington, DC 20016 202-537-6531 fax 202-537-6563 [email protected] The Reverend Robert Vitello U.S. Catholic Conference Catholic Campaign for Human Development 3211 4th Street, NE Washington, D.C. 20017 Ph: 202-541-3367 Fax: 202-541-3329 The Reverend Sherman Hicks First Trinity Lutheran Church 309 E St., NW Washington, D.C. 20001 Ph: 202-737-4859 Fax: 202-628-0571 Dr. Sayyid Syeed General Secretary Islamic Society of North America Post Office Box 38 Plainfield, IN 46168 317-839-1812 FAX 317-839-1840 The Reverend Kenneth Prunty 1146 Opal Street #104 Broomfield, CO 80020-7054 303-465-9250 (no fax) Bishop P.D. Jakes The Potters House 6777 West Kiest Boulevard Dallas, TX 75236 214-331-0954 FAX 214-333-6497 3. Faith-Based Development Organization Representatives 3.a. Denominational Development Organizations Ralph Watts President Adventist Development and Relief Agency 12501 Old Columbia Pike Silver Spring, MD 20904 301-680-6364 FAX 301-680-6370 Mr. Iqbal Noor Ali Chief Executive Officer Aga Khan Foundation USA 1901 L Street NW Suite 700 Washington, DC 20036 202-293-2537 FAX 202-785-1752 The Right Reverend John Ricard Bishop of Pensacola and Chairman, Catholic Relief Services 11 North B Street Pensacola, FL 32522 850-432-1515 FAX 850-436-6424 Sister Ann Duggan AIDS Coordinator Catholic Relief Services 209 West Fayette Street Baltimore, MD 21201 410-625-2220 FAX 410-234-3178 Sandra Swan Executive Director, Episcopal Relief and Development 815 2nd Avenue, 2nd Floior New York, NY 10017 212-716-6020 FAX 212-983-6377 Susanne Riveles, PhD Director, Africa Campaign, Lutheran World Relief 700 Light Street Baltimore, MD 21230-3850 Tel 410-230-2808 Fax 410-230-2882 Captain Ian Campbell The Salvation Army International Headquarters 101 Queen Victoria St London EC4P 4EP United Kingdom 011-[44] 20 7332 0101 FAX 011-[44] 20 7236 4981 011-44-207-332-8080 FAX 011-44-207- The Rev. Randolph Nugent, General Secretary General Board of Global Ministries, United Methodist Church 475 Riverside Drive, Room 350 New York, NY 10115-0111 (212) 870-3606 FAX (212) 870-3748 Marian McClure Director Worldwide Ministries Division Presbyterian Church, USA 100 Witherspoon Street Louisville, KY 40202 Ph: (502) 569-5000 Fax: 502-569-8039 3.b. Non-denominational/Interfaith Development Organizations (alphabetically by organization name) Ted Barnett, Ed.D. US Director Africa Inland Mission P.O. Box 178, Pearl River, NY 10965 Tel 914-735-4014 Fax 914- Church World Service Paul Derstine President Interchurch Medical Assistance College Avenue Box 429 New Windsor, MD 21776 410-635-8720 FAX 410-635-8726 Michael Nyenhuis President and CEO Medical Assistance Programs (MAP) International P.O. Box 215000 Brunswick, GA 31521-5000 Street Address for overnight: 2200 Glynco Parkway, Brunswick, GA 31525 912-280-6633 FAX 912-265-6170 The Reverend Franklin Graham Chief Executive Officer and Chairman of the Board Samaritan's Purse 801 Bamboo Road Boone, NC 28607 828-262-1980 FAX 828-262-0836 Richard Stearns President World Vision United States 34834 Weyerhaeuser Way South Federal Way, WA 98001 888-511-6598 FAX 253-815-3447 email rstearns@worldvision,org 4. US AIDS Leaders Your list 5. Others Jesse Milan, Jr. Esq Vice President, ASI and Deputy Director CDC National Prevention Information Center Metroplaza One 8400 Colesville Road, Suite 200 Silver Spring, MD 20910 301-562-1000 FAX 301-562-1001 Debbie Runions 1403 McKennie Avenue Nashville, TN 37206 Ph: 615-226-3533 Fax: 615-226-3137 Pernessa C. Seele Chief Executive Officer The Balm in Gilead, Inc 130 West 42nd Street, Suite 1300 New York, NY 10036 212-730-7381 FAX 212-730-2551 Deborah Fraser-Howze President National Black Leadership Commission on AIDS, Inc. 105 East 22ⁿᵈ Street, Suite 711 New York, NY 10010 212-614-0023 212-614-0057 Dr. Lobsang Rapgay, Ph.D. 2206 Venecia Avenue West Los Angeles, CA 90064 Ph: 310-291-8332 Fax: 310-206-4310 The Honorable Imam W. Deen Mohammed W.D.M. Ministry P.O. Box 1061 Calumet City, IL 60409 Edwin C. Sanders II Senior Servant Metropolitan Interdenominational Church 2128 11th Avenue North Nashville, TN 37208 726-3876 259-9210 Sheik Ibraimo Avenida 25 de Setembro No. 1211 Maputo, Mozambique Fax: 258.1.303.596 Mme. Adama Maiga Vice President SIDAMA Union Nationale des Femmes Musulmanes du Mali Rue 230 Porte 37 Quartier, Mali Bishop D. Dinis Solomao Sengulane Avenida do Rio Tembe No. 299 Maputo, Mozambique Fax: 258.1.401093 Mission Fax: 258.1.492098 The Reverend Kenneth Prunty 1146 Opal Street #104 Broomfield, CO 80020-7054 (303) 465-9250 No Fax Bishop Diarmuid Martin Secretary Pontifical Council for Justice and Peace 01120 Vatican City State Europe Fax: 011-39-066-987-205 Reverend Daniel Hoffman Area Executive for Africa Region Common Global Ministries Board P.O. Box 1986 Indianapolis, IN 46206 Ph: 317-713-2552 Fax: 317-635-4323 Bishop Chandler D. Owens Church of God in Christ 406 Roswell St. Marietta, GA 30060 Ph: 770-590-8510 Fax: 770-590-7354 Father Orlando Navarro San Jose, Costa Rica Ph: 506-219-6531 Fax: 506-219-6532 Email: [email protected] The Right Reverend Priamo Tejedo Retired Bishop 1000 Pinebrook Road Venice, FL Ph: 941-484-6852 Fax: same Linda Cutts Abbess Green Gulch Farm Zen Center 1601 Shoreline Highway Sausalito, CA 94965 Ph: 415-383-3134 Fax: 415-383-3128 A Consensus from Conscience: Revealing the Role of Faith in Response to AIDS White House World AIDS Day Summit 2000 November 30 December 1, 2000 Washington, DC International Participants Mengo, Kampala Uganda Mrs. Rahel Mussa Aron Tel: 256.41.270.708 The Evangelical Church of Eritria 256.41.270.077 Eritrea Fax: 256.41.270.708 Tel: 291. Email: [email protected] Fax: 291. Email: Dr. Rebecca Bunnell [email protected] Linda Kelley [email protected] Rebecca Rohrer [email protected] [email protected] Mission Fax: 291.1.125580 Imam Cisse Djiguiba Vice President His Supreme Holiness Patriarch Buor Kry National Islamic Council Wat Botoum 22 B.P. 663, Abidjan 22 Sangkat Chatomuk Cote D'Ivoire Khann Daun Penh Tel: 225.20.203622 Phnom Penh Cell: 225.05.95.4375 Cambodia Fax: c/o USAID Tel: 855.15.911965 Email: Fax: 855.23.213049 Manogodjon Binate [email protected] Caroline Connolly - [email protected] USAID Fax: 225-22-41-3460 Tabara Dramé Pra Thanawat Techa Bunyo President Abbot Union Nationale des Femmes Musulmanes Huarin Temple du Mali Tungsatoke Sub District Mali Sunpatong District Tel: 223. Chiang Mai Fax: 223. Thailand Email: Tel: 6653.830.430 Fax: same Ursala [email protected] Mission Fax: 223.22.39.33 Caroline Connolly [email protected] El Hadj Ibrahima Sory Fadiga (contact by e- The Reverend Gideon Byamugisha mail in French only) (declined) Minister of Islamic Affairs Uganda Namierembe Diocese Guinea Box 14297 Tel: N/A Kampala-Balintuma Road Fax: N/A Adjacent UPMB Building Email: osfam3.mirinet.net.gn 1 Fax: 263.791-105 Cathy - [email protected] Email: Mission Fax: 224.41.19.85 Patrick Osewe - [email protected] Shiekh Hemed Bin Jumaa Bin Hemed c/o National Muslim Council of Tanzania The Reverend Zephania Kameeta P.O. Box 21422 Deputy Speaker Dar es Salaam The National Assembly of Namibia Tanzania Namibia Tel: 0741.603390 (cell) Tel: 264.0811275445 (cell) Fax: 264.63.293074 Nancy Godfrey - [email protected] Email: Jed Meline - [email protected] Mission Fax: 255.22.211.65.59 Monica - [email protected] Cell phone: 264.61.225935 John Beed - [email protected] Shiek Abdurahman Hussien Chairman The Ethiopian Supreme Islamic Council The Most Reverend Emmanuel Kolini Ethiopia Archbishop of Province Rwanda Tel: 251. Rwanda Fax: 251. Tel: 250.083.02276 Email: Cell: 250-71231/Office: 514161 Fax: 250.514.160 or 73213 Vathani Amirthanayagam [email protected] Email: [email protected] Mission Fax: 251.151.0043 Eric Kagame - [email protected] Chris Barratt - [email protected] Sister Joan English Nazareth House P.O. Box 12116 Mr. Nicta Lubaale Cape Town, 8010 Organizational African Instituted Churches South Africa Post Office Box 21736 Tel: 27-21-461-1635 Nairobi Fax: 27-21-461-6414 Kenya Email: [email protected] Tel: 254.566.628 Fax: 254.21736 Ken Yamashita - [email protected] Email: [email protected] Mission Fax: 27.12.323.6443 [email protected] Emma Njuguna - [email protected] The Reverend Christopher Jokomo [email protected] Bishop Dana Vogel - [email protected] United Methodist Church 163 Chinhoyi Street Harare Alhaji Macciddo Zimbabwe President Tel: 263.751.508/9 Supreme Council for Islamic Affairs Home Tel: 263-490-282 The Sultanate Sokoto, Sokoto State 2 Nigeria Post Office Box 30068 Tel: 234.060.237.532 Capital City Fax: 234. Lilongwe 3 Email: Malawi Tel: 265.783.499 Lynn Gorton - [email protected] Fax: 265.783.106 Mission Fax: 234.161.4698 Joan LaRosa - [email protected] Mission Fax: 265.78.3181 His Eminence Sunday Mbang President Christian Association of Nigeria Archbishop Ndingi Mwana -a Nzeki Wesley House Catholic Church of Kenya 21/22 Marina Post Office Box 14231 P.O. Box 2011, Marina Nairobi Lagos Kenya Nigeria Tel: 254.241.391 Fax: 254.447027 Tel: 234.1.263.1853/264.6991 Fax: 234.1.263.2386 Email: [email protected] Email: Emma Njuguna - [email protected] Lynn Gorton - [email protected] [email protected] Mission Fax: 234.161.4698 Dana Vogel - [email protected] The Rt. Reverend Thomas Mensah The Most Reverend Ngonkulu Bishop of Obuasi Ndungane Ghana Archbishop Tel: 233. Diocese of Capetown Fax: 233. 16 Bishopscourt Drive Claremont 7700 Email: South Africa Tel: 27.021.761.2531 Joseph Amuza, PHS Fax: 27.021.797.1298. Robert Pond - [email protected] Email: Mission Fax: 233.21.773465 Ken Yamashita - [email protected] Mission Fax: 27.12.323.6443 Emery Mpwate Democratic Republic of Congo Tel: The Reverend Ramino Paul Abraham Fax: Email: FJKM Amparibe Famonjena 21, Lalana Andriambelomasina Reggie Hawkins - [email protected] 101 Antananarivo Mission Fax: 243.880.3274 Madagascar Tel: 261.20.22.23642 Fax: 261. The Reverend Dr. Augustine Musophole Email: General Secretary Malawi Council of Churches Susan Anthony - [email protected] 3 Mission Fax: 261.202.23.4883 Email: Felix Awantang - [email protected] His Holiness Abune Paulos Mission Fax: 221.823.29.65 Patriarch Ethiopian Orthodox Church Ethiopia Mr. Jean Sossaminou Tel: 251. Permanent Secretary of the President of Fax: 251. Benin Association for Traditional Religion Email: BP: 71 Se in Mono Benin David Losk - [email protected] Tel: 229.41.11.56 Mission Fax: 251.151.0043 Fax: 229. Email: Polycarp Cardinal Pengo Pascal - [email protected] P.O. Box 167 Alicia Dinerstein - [email protected] Dar es Salaam Mission Fax: 229.30.12.60 Tanzania Tel: 255.22.2113223 - office 255.22.2850882 - home Mrs. Bridget Syamalevwe Fax: 255.22.2125751 UN appointee in the Ministry of Education Email: [email protected] Ministry of Education Headquarters Box 50093 Nancy Godfrey - [email protected] Lusaka Jed Meline - [email protected] Zambia Mission Fax: 255.22.211.65.59 Tel: 260.1.250.855 Fax: 260.1.293.763 Email: Dr. Magid Kagimu Salongo (Dr. Kagimu) Chairman Michael J. Kelly, S.J. - [email protected] Islamic Medical Association of Uganda Robert Clay - [email protected] P.O. Box 2773 Mission Fax: 260.125.4532 Kampala Uganda Tel: 256. The Rt. Reverend James Tengatenga Fax: 256. Bishop Email: Anglican Diocese of Southern Malawi Private Bag, Chilema, Zomba Dr. Rebecca Bunnell - Malawi [email protected] Tel: 265.531.244 Rebecca Rohrer - [email protected] Fax: 265. Email: [email protected] Monsignor Theodore Adrien Sarr Joan LaRosa - [email protected] Senegal Mission Fax: 265.78.3181 Tel: Fax: Sheik Ibraimo Avenida 25 de Setembro No. 1211 4 Maputo, Mozambique Fax: 258.1.303.596 Mme. Adama Maiga Vice President SIDAMA Union Nationale des Femmes Musulmanes du Mali Rue 230 Porte 37 Quartier, Mali Bishop D. Dinis Solomao Sengulane Avenida do Rio Tembe No. 299 Maputo, Mozambique Fax: 258.1.401093 Mission Fax: 258.1.492098 Bishop Diarmuid Martin Secretary Pontifical Council for Justice and Peace 01120 Vatican City State Europe Fax: 011-39-066-987-205 Father Orlando Navarro San Jose, Costa Rica Ph: 506-219-6531 Fax: 506-219-6532 Email: [email protected] 5 Approved 15/8/00 NORA DEMPSEY BMC DRAFT DOD TALKING POINTS FOR POTUS TRIP TO NIGERIA I am pleased to announce that the USG will send a Defense team to Abuja in September to begin planning for Nigerian military participation in our LIFE program. The thrust of our military programs is in the areas of prevention, training and education assistance, designed specifically to reduce the HIV prevalence rate in the Nigerian defense forces. In addition, our Department of Defense, in conjunction with other federal agencies, will work hard to extend existing international programs into the Nigerian Defense Force including support to family members, hospice care and demobilized forces. OPTIONAL FORM 99 (7-90) FAX TRANSMITTAL # of pages 1 To KenBernard From D.Hamon Phone # Dept./Agency NSC Fax # 2024569390 202456 Fax # NSN 7540-01-317-7368 5099-101 GENERAL SERVICES ADMINISTRATION 8- 4-00 ; 4:38PM;ILAB :202 219 5980 # 6 U.S. Department of Labor DILABOR OF LABOR UNITED STATES OF OFFICIALION FAX TRANSMISSION DEPUTY UNDER SECRETARY FOR INTERNATIONAL LABOR AFFAIRS 200 Constitution Ave, N.W. Washington, D.C. 20210 Telephone: (202)693-4770 Facsimile: (202) 693-4780 To: Lauren Tabak Date: 8/4/00 Fax Number: 456 9260 Number of Pages 6 (Including Cover Sheet) From: Mac Arthur Deshazer Subject: COMMENTS: the revised deliverable event sheets are attached, including the HIV/AIDS piece. Mac Deshaze will be th DOL representative at NSC Nigorin PMP meetings. All deliverables ae Funded cut of DOL: current or FY 2001 Funds. 8- 4-00; 38PM; ILAB :202 219 5980 # 2/ 6 HIV/AIDS - Lagos or Kano U.S. DEPT. OF LABOR POTUS NIGERIA VISIT RECOMMENDATION FOR HIV DELIVERABLE 1. Theme: Workplace-based HIV/AIDS Education and Prevention 2. Deliverable: Announcement of a $500,000 USDOL project to initiate workplace-based HIV/AIDS education and prevention, working with Nigerian labor unions, employers, and the Ministry of Labor. Although official estimates estimate Nigeria's HIV seropositivity rate at 5.4%, some health experts put the rate at double that figure. Some areas in Nigeria are already showing 21% seropositivity rates in pregnant women. Intervention in Nigeria's HIV/AIDS epidemic at this critical, early stage could help prevent levels from soaring to those rates now seem in southern Africa, which could have serious repercussions for the entire west African region. President Obasanjo has recently identified the need for stronger protection against discrimination in the workplace based on HIV seropositivity. This signals a high-level awareness of and commitment to the crisis and to the importance of this particular aspect of the problem.. Fear of discrimination and social stigmatization are among the most serious obstacles to affecting behavior change pertaining to HIV. The workplace is one of the most powerful platforms from which one can work to confront the stigma issues, by helping ensure financial and social stability to individuals with AIDS. It is also an ideal site from which to perform education efforts for at-risk adults. Trade unions are among the more robust elements of civil society in Nigeria, and can provide a strong foundation for developing a program. This also offers an opportunity to partner with employers, giving the program sustainability; collaboration with the Ministry of Labor will afford the chance to help build capacity in one of Nigeria's neglected and troubled government institutions. 3. Event: The President will visit an apparel assembly plant to announce the launching of a workpace- based HIV/AIDS education and prevention project in Nigeria. POTUS will meet with labor leaders, employers representatives, Ministry of Labor officials, and representatives of the Nigerian Network of Persons Living with HIV/AIDS. The President will acknowledge in his remarks the critical need for partnerships between unions and employers, public and private sector, and Nigerian and international institutions to combat HIV/AIDS. He will discuss workplace's ability to become a powerful tool for fighting discrimination and stigma, and for furthering education efforts. The apparel plant will also serve as an effective visual backdrop for the recently passed Africa Growth and Opportunity Act (AGOA), which stressed apparel production. The project will have the opportunity to connect with ongoing projects of USAID on HIV in Nigeria, and address linkages between HIV and trade, as spelled out in the AGOA. 4. Location: Unionized apparel assembly plant in Kano. 5. Time Needed for the Event: 45 minutes 6. Funding: $500,000 allocated against DOL's FY2001 bilateral funding, if approved. 7. Contact: MacArthur DeShazer, Associate Deputy Under Secretary, Bureau of International Labor Affairs, U.S. Dept. of Labor, phone: 202-693-4770; fax: 202-693-4780 8- 4-00; 4:38PM; ILAB ;202 219 5980 U.S. DEPARTMENT OF LABOR DELIVERABLE Nigerian Labor Exchange Program 1. Theme: Nigerian Labor Exchange Program: 2. Deliverable: Announcement of a $500,000 Labor Exchange program aimed at assisting the Government of Nigeria and the Lagos State Government establish effective and efficient Labor Exchange services in Lagos wthat will serve as a model for the improvement of employment services country wide, as well as provide employment services in Lagos on a pilot basis. 3. Event: No specific event 4. Location: Not applicable 5. Time needed for event: Include in POTUS remarks 6. Contact: MacArthur DeShazer, Associate Deputy Under Secretary, Bureau of International Labor Affairs, U.S. Department of Labor, Phone: 202-693-4770; Fax: 202-693-4780 :202 219 5980 # 4/ 6 8- 4-00; 4:38PM; ILAB U.S. DEPARTMENT OF LABOR DELIVERABLE Veterans Employment Services 1. Theme: Veterans Employment Services: To assist the Government of Nigeria establish effective and efficient programs that help ease the transition of veterans from the uniformed services to appropriate employment in the civilian workforce. 2. Deliverable: Announcement of a $300,000 (DOL bilateral funds)Veterans Employment Services program with the Government of Nigeria to accomplish the following: Identify cost-effective and efficient strategies to prepare depaarting service members for civilian employment. Establish the Nigerian Armed Forces Resettlement Center at Oshodi as a model veterans' outplacement center. Assist with designing a realistically scaled outplacement service - - in addition to the Resettlement Center - to assist departing service members find civilian employment. Assist in development of a strategy for periodic assessment of Resettlement Center services as to effectiveness, efficiency, continued need and alternatives such as outsourcing. 3. Event: No specific event 4. Location: Not applicable 5. Time needed for event: Include in POTUS remarks 6. Contact: MacArthur DeShazer, Associate Deputy Under Secretary, Bureau of International Affairs, U.S. Department of Labor, Phone: 202-693-4770; Fax: 202-693-4780 8- 4-00; 4:38PM; ILAB :202 U.S. DEPARTMENT OF LABOR DELIVERABLE Child Labor 1. Theme: National Program to Eliminate the Worst Forms of Child Labor: The program brings Nigeria, for the first time, into the International Labor Organization's International Program on the Elimination of Child Labor (IPEC) to which the U.S. Government contributed $30 million each year for the past two years. Its goals are to strengthening the capacity of the government, non-governmental organizations, and workers' and employers organizations to combat child labor; implementing direct action pilot projects; and increasing public awareness about the hazards of child labor. 2. Deliverable: Announcement of a $1 million National Program to Eliminate the Worst Forms of Child Labor. The Nigerian First Lady, Ms. Stella Obasanjo is the Honorary Chair of the National Program to Eliminate the Worst Forms of Child Labor. Late last year, she agreed to accept this position during a dialogue with Labor Secretary Alexis Herman. A Memorandum of Understanding (MOU) signing ceremony for this program between the Government of Nigeria and the International Labor Organization/IPEC officials will take place August 8, 2000, in Abuja, Nigeria. The plan of action calls for removal of approximately 3000 children from work and provided with educational opportunities in pilot projects. The funds noted above include $718,928 for the National Program to Eliminate Child Labor in Nigeria and $282,613 for a statistical program aimed at generating reliable data on child labor which can be used to develop effective interventions against child labor in Nigeria and to build the national capacity to conduct child labor surveys at regular intervals in the future. The project was approved in December 1999, Project Agreement between ILO and the Federal Office of Statistics was signed in January 2000. Preliminary preparatory activities started immediately. The pilot test for the Statistical Program was conducted from May 2, June 2000. 3. Event: No specific event 4. Location: Abuja, Nigeria 5. Time needed for event: Include in POTUS remarks. 6. Contact: MacArthur DeShazer, Associate Deputy Under Secretary, Bureau of International Labor Affairs, U.S. Department of Labor, Phone: 202-693-4770, Fax: 202-693-4780 8- 4-00; 4:38PM; ILAB ;202 219 5980 U.S. DEPARTMENT OF LABOR DELIVERABLE Industrial Relations 1. Theme: Industrial Relations: To promote democratic trade unionism, collective bargaining, and conflict resolution in Nigeria 2. Deliverable: Announcement of a two year (September 2000 - August 2002), $2 million project to improve the state of industrial relations in Nigeria through training trade unions and employers in relevant labor laws, promotion of collective bargaining, conflict prevention and dispute resolution, and the strengthening of executive and judicial systems responsible for administering national labor law. (DOL/ILAB 1999 bilateral funds that will be obligated in September) The prevailing democratic environment in Nigeria provides a unique opportunity to underpin the institutions and processes of industrial relations which have deteriorated and became dysfunctional during the long military dictatorship. This requires measures to help the social partners in rebuilding their organizations and in strengthening their capacity to consult and negotiate agreements, and to resolve disputes. Project conducted in collaboration with the International Labor Organization 3. Event: No specific event 4. Location: Not applicable 5. Time needed for event: Include 6. USAID will add a bullet to the above deliverable - not yet received by confirmed with Jennifer Winsor!! 7. MacArthur DeShazer, Associate Deputy Under Secretary, Bureau of International Labor Affairs, U.S. Department of Labor, Phone: :202-693-4770; Fax: 202-693-4780 Nova FYI Colby hold copy for trip book prep DoD Non-Paper Proposed DoD Prevention Activities for African Military and Uniformed Services BACKGROUND The AIDS epidemic on the African continent is remarkably complex. HIV incidence and prevalence, the demographics of populations at risk, risk behaviors, the rural vs. urban distribution of HIV, and access to basic education/prevention activities all vary regionally and country by country. Moreover, the mixture of HIV types, groups, subtypes, and recombinants varies widely across Africa. A regional, and sometimes a country-specific, approach to primary AIDS prevention is required. In East Africa, the HIV-1 epidemic was already established by the 1980's and is centered around population centers and routes of commerce. HIV-1 subtypes A, C, and D and their recombinants predominate. The prevalence in most of East Africa has been relatively stable in the last 15 years. In much of Southern Africa, the largely HIV-1 subtype C epidemic is only about 10 years old, but has achieved a high prevalence in a short time, largely centered in urban areas. In West Africa, HIV-2 has been present for a long time, but the HIV-1 epidemic, mostly due to an A/G recombinant IbNG, started more recently. Prevention in that region must entail consideration of both types of HIV. In West Central Africa all of the subtypes of HIV-1 are present in the region, as well as the 'O' and 'N' groups. The prevalence is relatively low, and not dissimilar in rural and urban areas. HIV-1 + HIV-2 Prevalence 7% Urban = Rural HIV-1 Subtype: AG recombinant HIV-1 Prevalence 10% HIV-1 Urban > Rural Prevalence 5% HIV-1 subtypes: A, D Urban = Rural HIV-1 subtypes: HIV-1 Prevalence 30% Urban > Rural HIV-1 subtype: C HIV on the African Continent intervention in African military populations. It has been demonstrated that assessment of knowledge, attitudes, and behaviors, coupled with serial prevalence or incidence measurements, can be done while maintaining confidentiality and with a high level of voluntary participation. The U.S. military population is exposed to multiple HIV subtypes while on deployment, in response rapid diagnosis of HIV subtypes have already 1 been developed. There are a number of factors contributing to HIV risk. These include travel away from home base, alcohol use, and economic means to use commercial sex workers. Assessment of these components of HIV risk in African military populations will develop the regional profile to design and guide prevention activities. DEFINITIONS AND PERFORMANCE MEASURES 1. Regional specific military-based education. Based on findings of the regional diversity of AIDS in Africa and through work with UNAIDS, regional scientists, and African militaries, military-based education will be directed to four specific African regions: East, South, West, and West-Central, respectively. The approach will proceed by stages: assessment of HIV prevalence and risk behaviors development of a regional prevention plan implementation through training and development of infrastructure evaluation of the effect of prevention refinement and incorporation into the military culture for enduring impact We will build on the unique DoD triservice military education programs developed to prevent alcohol abuse and STDs, as well as the region-specific HIV prevention work by NGOs and USAID. Anonymous serosurveys with risk behavior data collection will begin as soon as feasible (see attached questionnaire developed by the Naval Research Unit in San Diego (NHRC) and utilized by the Navy, which has been expanded to all services). Current educational modules created by the NHRC and Johns Hopkins University (JHU) will be culturally adapted to the targeted areas in Africa. This group education module, focusing on altering behavior, will be instituted. The initial round of serosurveys and risk behavior assessment will take a minimum of six months. A "train the trainer" approach that has been very successful within the U.S. Air Force will be used. This training can occur simultaneously within the different regions and will be completed within three months. All of these programs will be coordinated with similar USAID activities. For example, education concerning condoms, counseling, and testing of general populations. The trained educators will then intensively educate specifically selected military units where anonymous serosurveys have been completed within the first round. Post education serosurveys with risk behavior assessment will again be completed and compared with the original information to assess impact. 2 In other areas of the world where this approach has been successfully implemented, i.e. SE Asia, incidence markedly declined and upon release from the military these individuals became peer educators within their villages, expanding the impact of the original investment. The same scenario is visualized for this project, which is expected to make a substantial impact on reducing the impact of AIDS in African militaries. In addition to assessment of HIV seroprevalence, selected serum samples will be utilized for determinations of HIV type, group, and subtype. Because the distribution of HIV in different regions and populations group is incompletely known, this will provide essential information characterizing the epidemic in African militaries. This project is expected to contribute to long-term and sustained HIV prevention in Africa. The impact of HIV-1 subtype on clinical progression, transmission, and eventual vaccine efficacy is largely unknown. Assessment of HIV-1 subtypes in African military populations, with opportunity for follow-up, will permit an evaluation of these factors in many different settings, ranging from a virtually single-subtype epidemic in Southern Africa to a highly complex mixture of subtypes and recombinants in West Central Africa. Prevention activities can be focussed, not only on individuals at high risk, but also on regions and populations where the particular subtypes or mixtures of subtypes present the greatest challenge to prevention. 2. Enhanced military education of African UN Peace-Keeper forces. African military personnel deployed far from their home base for long periods in conjunction with UN peace-keeping activities may experience a different HIV risk profile than soldiers remaining at home. In conjunction with the ongoing UN peace-keeping project to combat HIV/AIDS, COL Peter Leenijes coordinated with the Ford Foundation, the Civil Military Alliance, and the U.S. Military HIV Research Program to develop a special intervention program targeted to the African military UN peace-keepers. The program was patterned on one currently being piloted through the South African Army field units. The current project involves five specific curriculum modules: Defining HIV and its impact in the military HIV Prevention Substance Abuse, HIV, STDs Risk Assessment and Prevention Strategies Course Summary AGENCIES ACTIVITIES 1. Regional specific military-based education. 3 The DoD, through the U.S. Military HIV Research Program, has been developing new educational modules specifically focusing on unique, military-associated risks. These new modules were developed after an extensive highly confidential behavior survey of new triservice military seroconverter study and an expansive assessment of HIV education and prevention needs in the U.S. military. These new modules are undergoing evaluation in a large Naval population overseas. Additional HIV/AIDS educational modules for 16-20 year olds developed by JHU are being adapted for evaluation within the army recruit population. A modification of these modules will be utilized for the initial assessment of African troops, after coordination with African militaries and USAID groups, and NGOs working in the region. The U.S. Military HIV Research Program already has ongoing research support and military connection in West Africa - Senegal and Cameroon, East Africa- Uganda, Tanzania, and Kenya, and through our joint UN effort in South Africa. 2. Enhanced military education of African UN Peace-keeper forces. The UN Peace-keeping educational initiative is already a coordinated effort between the UN Department of Peace-Keeping Operations and the Civil-Military Alliance, which has U.S. military support through LTC Craig Hendrix, USAF ret. For the past five years, William Lyerly - USAID, Manual Carballo - International Center for Migration and Health, and Peter Gordan - UN HIV and Development Programme have instituted this initiative. The curriculum developers were Donna Ruscavage and Paul Purnell of the U.S. Military HIV Research Program. COUNTRIES DoD recommends utilizing the U.S. military's current education and prevention programs and instituting new research within the regions and countries noted: First Tranche: Nigeria, Kenya, South Africa, Botswana, and Senegal Second Tranche: Benin, Mali, Malawi, Ghana, Uganda, Zimbabwe and Ethiopia 4 Summary of UV Waterworks Demonstrations Around the World General Background In economically deprived areas, waterborne diseases lead to illnesses and sometimes even death, especially in children. The unavailability or excessive cost of fuel prevents many families from boiling their water for disinfection before drinking it. A device for water disinfection was developed by DOE at the Lawrence Berkeley National Laboratory which allows water to be disinfected for much less energy than it would take to boil it. This device, called Ultra-Violet Waterworks (UVWw) uses ultraviolet light to disable viruses, bacteria, and protozoa. It requires only 40 watts of electricity to disinfect the daily needs of 1000 people and was specifically designed to be inexpensive and low maintenance for rural village applications in the developing world. The device does not require a pressurized water source (it can work with a hand held pump and a surge tank) and can operate powered by photovoltaics, without access to grid electricity. In 1996, researchers at Lawrence Berkeley National Laboratory licensed the system to Water Health International (WHI) in Napa, California. Water Health international holds an exclusive world wide license for the device (except for in India) and pays a 3.5% royalty on all sales, except those to the Federal Government, to the Lawrence Berkeley National Laboratory. The latest model can provide 10 liters of clean water daily to 1000 people at 10 cents per year per person. An individual device sells for about $620. Larger devices are available. South Africa Under the Gore-Mbeki Binational Commission, the Department of Energy's Lawrence Berkeley National Laboratory worked with the South African Center for Essential Community Services to conduct a field test of UVWw at the "Lily of the Valley" AIDS clinic outside of Durban. This clinic is a hospice for abandoned infants with the HIV antibody. For infants infected with the antibody, clean water can mean the difference between life and death. At the hospice, the untreated water was contaminated with 4000 microorganisms such as E.coli per deciliter, while none were detectable after passing the water through the device. A solar-powered UV Waterworks demonstration system was installed in 1998 at the Greenock Clinic, a rural health clinic located near Dundee, KwaZulu-Natal. The clinic sees approximately 40 patients per day, most of them children complaining of diarrhea caused by contaminated water. The clinic's own groundwater supply has been contaminated by nearby pit latrines but requires no pre-filtration before UV treatment. This installation was made possible under a grant from the U.S. Department of Energy to the Lawrence Berkeley National Laboratory, using UV Waterworks units donated by WaterHealth International. Philippines WHI's Philippines distributor has established 37 "Aqua Sure" water stations in urban areas and 30 community water centers in rural areas of the Philippines. At these installations, people without access to reliable drinking water can buy water (which is treated by UV Waterworksᵀ plus pre-filters) for one-third the cost they are paying for bottled water. Approximately 50,000 people are now being served daily by UV WaterworksM-treated water in the Philippines. In addition, the Rotary Club has allotted funds for nine Philippine public schools to be outfitted with community water centers. Mexico WHI installed its first integrated community water system near Acapulco in Zihuatenejo (Guerrero State), Mexico in late 1998. The system can provide clean water for 2,000 people daily. It includes sand and roughing filters to remove turbidity and cysts, solar panels for its electrical requirements, and UV Waterworks for treatment of bacterial and viral contamination WHI recently installed60 smaller-scale systems in rural clinics throughout Guerrero. An additional 40 systems will be installed in early2000. Two non- profit organizations - A Cup of Water and the Clearwater Project - will install a community water disinfection system at Tunzingo, Guerrero, Mexico, in early 2000. Bangladesh In areas throughout Bangladesh where boreholes are heavily contaminated with arsenic, WHI's water disinfection systems provide an immediate alternative of switching to surface water as a source of clean drinking water. WHI installed its first Bangladesh demonstration unit in May 1999 with the support of Energy, which made a gift of WHI's equipment to the people of Bangladesh. The initial demonstration unit is a compact water station that includes four mechanical pre-filters to remove large particles, fine turbidity and cysts, a carbon filter to remove dissolved chemical contaminants, and a UV Waterworks unit to treat bacterial and viral contamination. The station can provide water for approximately 2,000 people daily. WHI hopes to install additional community water systems in rural areas throughout Bangladesh in 2000. In doing so, WHI will work closely with the Bangladesh government, international agencies and respected Bangladeshi NGOs. In urban areas, Golden Fair Trading Company (WHI's agent in Bangladesh) is commercially marketing WHI's products. Nigeria In Nigeria, USDOE installed one unit outside of Abuja that Secretary Richardson dedicated, and DOE (with USAID) had hoped to deploy thousands of similiar units in villages around the country. The whole program was dependent on USAID's efforts at organizing communities on the local level to be able to manage the operation and maintenance of simple community projects, like the UV waterworks. USAID's efforts at creating community level political entities have not met with the success they had hoped for, in spite of a major effort over the past two years, so they never felt it would be a good investment to provide communities with the waterworks, as they would be vandalized, stolen, or broken for lack of maintenance in a very short time. Unfortunately, this is what happened to the one unit installed in what is really a suburb of Abuja. The local chief took it over for his own use, some small parts broke, and the system was kaput in a very short time. India UV Waterworks technology was field tested in India and in 1996, Lawrence Berkeley Laboratory granted a license for its manufacture and sale in India to Urminus Industries in Bombay, which manufactures the outer shell of aluminum (as opposed to thermoplastics used by Waterworks International elsewhere in the world). Possible Talking Points for USG Meeting on AIDS Vice President's Ceremonial Office Friday, July 21,2000 1:15 p.m. The Department of Energy was asked to come to this meeting today to discuss UV waterworks technology and its potential to be mixed with infant formula to combat AIDs transmission through mother's milk. We believe the technology has excellent potential but the Department of Energy does not have the funds to implement the technology. As you know, millions of South Africans do not have access to safe drinking water. In economically deprived areas, waterborne diseases lead to illnesses and sometimes even death, especially in children. The unavailability or excessive cost of fuel prevents many families from boiling their water for disinfection before drinking it. A device for water disinfection was developed by DOE at the Lawrence Berkeley National Laboratory which allows water to be disinfected for much less energy than it would take to boil it. This device, called Ultra-Violet Waterworks (UVWw) uses ultraviolet light to disable viruses, bacteria, and protozoa. It requires only 40 watts of electricity to disinfect the daily needs of 1000 people and was specifically designed to be inexpensive and low maintenance for rural village applications in the developing world. The device does not require a pressurized water source ( it can work with a hand held pump and a surge tank) and can operate powered by photovoltaics, without access to grid electricity. The latest model can provide 10 liters of clean water daily to 1000 people at 10 cents per year per person. An individual device sells for about $620. Under the Gore-Mbeki Binational Commission, the Department of Energy's Lawrence Berkeley National Laboratory worked with the South African Center for Essential Community Services to organize a field test of UVWw at the "Lily of the Valley" AIDS clinic outside of Durban. This clinic is a hospice for abandoned infants with the HIV antibody. For infants infected with the antibody, clean water can mean the difference between life and death. The biweekly monitoring of the unit indicated adequate performance with no detectable coliform bacteria in the water, reduced from 4000 microorganisms per deciliter. A solar-powered UV Waterworks demonstration system was installed in 1998 at the Greenock Clinic, a rural health clinic located near Dundee, KwaZulu-Natal. The clinic sees approximately 40 patients per day, most of them children complaining of diarrhea caused by contaminated water. The site test is ongoing We have been struggling a bit with the second site, as we have encountered vandalism of some outdoor components of the PV-powered system, and some problems with the reporting of the bacterial tests of the water quality. Researchers at LBNL visited the site in February, 200 and report that they believe that these problems have been now solved. In 1996, researchers at LBNL licensed their UV Waterworks disinfection system to WaterHealth International in Napa, California. WaterHealth International holds an exclusive worldwide license for the device and pays the government a 3.5% royalty. A U.S. government entity purchasing UV waterworks devices pays no royalty charge. Potential for Distribution We examined three ideas for broad implementation of the UV Waterworks system in Africa. 1. USAID / Private Foundation funding: UV waterworks system could be funded through grants to rural organizations. This costly on a broad scale but could be used to demonstrate the benefits of the technology and as a public relations effort to gain rural population buy-in. 2. Micro credit/Franchise sales: With a micro-credit loan program, local water sales entrpreneurs could sell purified water and recover the cost to the equipment as well as enhance economic growth in the community. 3. Private Industry sponsorship. The Department of Energy has been approached by the pharmaceutical industry_regarding cooperation between UV Waterworks technology and drugs for combating AIDS. We plan to follow up with them to discuss this idea further. Closing We are eager to work with other interested agencies to bring UV waterworks technology to bear on meeting this need. I have copies of our initial memo for Leon Fuerth (with a technology brochure) and a summary of world wide demonstrations of the device. U.S. DEPARTMENT OF ENERGY OFFICE OF INTERNATIONAL AFFAIRS OFFICE OF AFRICAN AND AMERICAN AFFAIRS 1000 INDEPENDENCE AVENUE, SW WASHINGTON, DC 20585 202/586-6140 (PHONE) 202/586-0013 (FAX) FAX COVER SHEET TO: Jim Babbitt FROM: Andrea Lockwood COMPANY: DATE: 7/14 FAX NUMBER: 456-9500 TOTAL NO. OF PAGES INCLUDING COVER: 7 PHONE NUMBER: SENDER'S PHONE NUMBER: 586-2518 RE: Request for information on UVWaterworks for Leon Fuerth ARTMENT OF ENERGY Department of Energy Washington, DC 20585 OF MEMORANDUM FOR Leon Fuerth, Senior Foreign Policy Advisor to the Vice President FROM: David Goldwyn, Assistant Secretary for Se Office of International Affairs SUBJECT: UV Waterworks Technology: Gore-Mbeki Binational Commission Experience and Potential Applications in AIDS battle Issue You requested a brief backgrounder on the UV Waterworks technology that had been field tested in South Africa under the auspices of the Gore-Mbeki Binational Comission and the potential for its use in combining clean water with powdered infant formula to prevent the transmission of AIDS to infants through mother's milk. We believe the technology has excellent potential and will examine some proposals for funding in this paper. Background Millions of South Africans do not have access to safe drinking water. In economically deprived areas, waterborne diseases lead to illnesses and sometimes even death, especially in children. The unavailability or excessive cost of fuel prevents many families from boiling their water for disinfection before drinking it. A device for water disinfection was developed by DOE at the Lawrence Berkeley National Laboratory which allows water to be disinfected for much less energy than it would take to boil it. This device, called Ultra-Violet Waterworks (UVWw) uses ultraviolet light to disable viruses, bacteria, and protozoa. It requires only 40 watts of electricity to disinfect the daily needs of 1000 people and was specifically designed to be inexpensive and low maintenance for rural village applications in the developing world. The device does not require a pressurized water source (it can work with a hand held pump and a surge tank) and can operate powered by photovoltaics, without access to grid electricity. The latest model can provide 10 liters of clean water daily to 1000 people at 10 cents per year per person. An individual device sells for about $620. Under the Gore-Mbeki Binational Commission, the Department of Energy's Lawrence Berkeley National Laboratory worked with the South African Center for Essential Community Services to organize a field test of UVWw at the "Lily of the Valley" AIDS clinic outside of Durban. This clinic is a hospice for abandoned infants with the HIV Printed with soy ink on recycled paper antibody. For infants infected with the antibody, clean water can mean the difference between life and death. A team from LBNL was in South Africa from July 19 to August 7, 1997, to set up and begin monitoring the performance of the UVWw system. The biweekly monitoring of the unit indicated adequate performance with no detectable coliform bacteria in the water. Following this field test and field tests in India in 1996, researchers at LBNL licensed their UV Waterworks disinfection system to WaterHealth International in Napa, California. WaterHealth International holds an exclusive worldwide license for the device. Potential for Distribution We examined three ideas for broad implementation of the UV Waterworks system in Africa. 1. USAID / Private Foundation funding: UV waterworks system could be funded through grants to rural organizations. This is costly on a broad scale but could be used to demonstrate the benefits of the technology. This could also drive a public relations effort to gain rural population buy-in. 2. Micro credit/Franchise sales: With a micro-credit loan program, local water salesmen/entrepreneurs could sell purified water and recover the cost to the equipment as well as enhance economic growth in the community. 3. Private Industry sponsorship. The Department of Energy has been approached by the pharmaceutical industry regarding cooperation between proponents of UV Waterworks technology and drug manufacturers interested in combating AIDS. We plan to follow up with them to discuss this idea further. WATERHEALTH UV 1700 Soscol Avenue, Suite 5 Napa, California 94559 U.S.A. WATERWORKS For more information contact us at: Phone: 707-252-9092 RELIABLE, Fax: 707-252-1514 AFFORDABLE E-mail: [email protected] WATER Web site: DISINFECTION www.waterhealth.com UV WATERWORKS SAFE DRINKING WATER FOR SINGLE HOMES OR ENTIRE COMMUNITIES UV Waterworks is an efficient, affordable water disinfection device that uses ultraviolet light to quickly and reliably disable bacteria and viruses in drinking water, making it safe to drink. Low purchase price, simple operation and low operating cost make UV Waterworks practical and affordable for a wide range of uses, from rural communities in developing nations to individual residences in developed countries that lack access to centralized water disinfection. EASY SET UP, LOW MAINTENANCE UV Waterworks' small size, light weight and simple gravity-feed operation mean that it can be installed virtually anywhere there is a water supply and electricity. Maintenance consists only of cleaning the water pan with a damp cloth once every six months*, replacing the UV lamp once a year, and replacing the ballast at least every ten years.* RELIABLY DISINFECTS 1,000 LITERS OF OTHER BENEFITS INCLUDE: WATER FOR LESS THAN 5 CENTS UV Waterworks uses no chemicals. Imparts no With no moving parts and requiring only 40 watts taste or odor to water; has no risk of overdose. of power, UV Waterworks reliably disinfects Does not require pressurized water to work. 4 gallons of water (15 liters) per minute. That's Costs less than comparable systems. Eliminates the need to purchase fuel or enough to serve 500-1,500 people if used for gather wood to boil and purify water. drinking water and cooking at low usage rates, Suitable for a wide range of uses, including: or up to 150 homes at higher usage rates. rural communities, single residences with PROVEN GERMICIDAL EFFECTIVENESS wells, farms, hospitals, and more. Easily powered by a car battery, a bicycle UV Waterworks contains a germicidal ultraviolet generator, wind, solar cells or a small (UV) lamp positioned over a shallow water hydroelectric source. pan. Water flows through the unit by gravity, staying in the chamber 12 seconds to ensure The adequate disinfection. Delivering a UV dosage Discover Magazina Discover Magazine's of over 80,000 microwatt-seconds - per cm², Award for UV Waterworks di lables 99.995% of water- Technological Innovation borne bacteria an viruses. (Environment Category) More often if the water itams - chemicals that create a film on the vater pan or a lot 01 blid matter Popular Science Magazine's In t: 8 Ultra mo lel the UV meter and solenoid vaive must Best of What's New Award be eplaced penudically ANSWERS TO YOUR QUESTIONS ABOUT UV WATENWORNO Q. HOW SAFE IS ULTRAVIOLET DISINFECTION? Q. HAS UV WATERWORKS BEEN PROVEN UNDER Q. HAVE FIELD TESTS PROVEN EFFECTIVE? CONTROLLED CONDITIONS? A. EXTREMELY SAFE. A. AGAIN, YES. A. YES. Rapid and inexpensive, UV light is a World Health Weekly tests of UV Waterworks conducted over five Organization-approved method of disinfecting Tests were conducted by the Lawrence Berkeley months in several Philippine communities demon- drinking water.' A UV dosage of 38,000 microwatt- National Laboratory using World Health Organization strated that highly polluted water (run through a seconds per square centimeter (cm2) disables the (WHO) protocols. These demonstrated that when two-micron filter to remove solid matter) contained most virulent bacteria. Typical UV systems provide a concentrations of colony-forming units of E. coli no measurable trace of bacteria or viruses after dosage of 25,000-35,000 microwatt-seconds per cm². per 100 ml of water were more than 100,000 at the being treated by UV Waterworks. inlet of UV Waterworks, the concentration at the UV Waterworks, however, delivers a minimum UV Waterworks successfully treated contaminated dosage of 80,000 microwatt-seconds outlet was less than one, thus meeting the per cm², more than enough WHO standard for drinking water. ground water from a borehole at a children's clinic near Durban, South Africa. The water contains to disable 99.995% of 38cm In separate tests, tap "wild" (as opposed to "laboratory") strains of waterborne bacteria 71cm 2'4" 15" water with no residual bacteria, which are more resistant to UV treatment and viruses. UV chlorine was than clean water dosed with pure cultures of the disinfection is spiked with high same organisms. not generally concentrations recommended 28cm of the infectious Results: Before entering the UV Waterworks unit, for long-term the South African water contained an average of waterborne storage of 11" 3,000 colony-forming units per 100 ml of water, pathogens water. UV listed below. including 200 fecal coliforms per 100 ml. Water Waterworks UV Waterworks leaving the UV Waterworks unit contained no effectively disinfects detectable coliforms (including E. coli) or other effectively Enterobacteriaceae. water with up to 20 disabled all of NTUs of turbidity and a the pathogens. In addition, extensive tests by the National UV extinction coefficient of Water Commission of Mexico confirmed .25/cm or lower. Turbidity can be reduced UV Waterworks' effectiveness. Guidelines for Drinking Water Quality, vol. 1, World Health with a settling tank, sand filter or other type of filter. Organization, Geneva, Switzerland, 1993, p. 135. SPECIFICATIONS Voltage: 120V AC, 220V AC or 12V DC PATHOGENS TESTED AGAINST Maximum Flow Rate: 15 liters (4 gallons) per minute Length: 71 centimeters (2 feet, 4 inches) Escherichia coli (ATCC-10148) People Served: 500-1,500 per unit (if used Width: 38 centimeters (15 inches) Salmonella typhi (NCTC-786) primarily for drinking water and cooking at low Vibrio cholerae (569 Inaba) usage rates), or up to 150 homes (at typical Height: 28 centimeters (11 inches) U.S. water usage rates) Streptococcus faecalis (water isolate) Weight: 7 kilograms (15 pounds) Clostridium welchii (water isolate) Cost per 1000 liters (one ton of water): 4 cents U.S. Shigella dysenteriae (clinical isolate) UV Dosage: Exceeds 80,000 microwatt-seconds Note: UV Waterworks under standard operation does per cm2 (more than enough to disable 99.995% of Proteus vulgaris (clinical isolate) not treat parasites or micro-organism cysts with waterborne bacteria and viruses) Klebsiella aerogenes (water isolate) protective coverings such as Cryptosporidium and Power Consumption: 40 watts (UVW Standard), Giardia. Such organisms are effectively removed by a Enterobacter cloacae (clinical isolate) 60 watts (UVW Ultra) flocculating agent, settling to nk or sand filter. Pseudomonas aeruginosa (Immunotype IV) ADDITIONAL EQUIPMENT & SERVICES WaterHealth International, Inc. offers the following equipment and services at additional cost. See product literature for more information. Spare parts: UV lamp and 120V AC, 220V AC or 12V DC ballast. Pressure control and water shutoff system: adjusts water flow from pressure source and controls water level in clean water storage tank. Sand and roughing filters: filter out turbidity and larger pathogens not effectively treated by UV Waterworks (e.g., Giardia, Cryptosporidium, amoebae and worms). RAW WATER 1 STORAGE INFLOW CUT OF OFF INFLOW SOURCE ROUGHING FILTER SAND FILTER UV WATERWORKS CLEAN WATER STORAGE Wind, solar or small hydroelectric power packages: wind turbines, solar panels and small hydroelectric power packages to operate UV Waterworks. Installation and maintenance services: engineering information for installation of units and associated equipment. Community education materials to assist communities to use the system properly. TECHNOLOGY SOLUTIONS UV light brings cheap, clean water to HIV babies N ear Durban, South Africa, an in- dipping a soiled hand or pot into the cis- can remove the larger parasites and other expensive ultraviolet disinfec- tern. Typically done over a biomass cook- floating particles from the water, said tion system is providing very stove, boiling is the most effective treat- Elwyn Ewald, president and CEO of clean drinking water for abandoned in- ment but is slow and labor-intensive, and WaterHealth. Collecting the disinfected fants with the HIV antibody. Not all of can use as much as 20,000 times more water in closed containers can minimize these babies are infected with the virus, energy than efficient UV treatment. the risk of recontamination. but for the fraction that are, disinfected The simplicity, low cost and speed of Other UV-based systems were imprac- water can mean the difference between UV disinfection justifies its use in less tical in the developing world because they life and death. technological communities, despite the require a pressurized water source. (These The system takes advantage of the ger- following limitations: UV light cannot communities tend to use surface or hand- micidal property of UV light, which only treat nonbiological pollution nor the par- pumped water that is not pressurized.) recently has been harnessed effectively asites Giardia and Cryptosporidium, and its In addition, because other systems sub- enough to work in a community with a disinfectant action offers no residual effect, merge the UV bulb in the water, biolog- low level of technology. Following field leaving it susceptible to recontamination. ical and chemical deposits accumulate on tests in rural Indian villages (see However, simple mechanical devices such the bulb's protective sleeve and necessitate Biophotonics International, March/April as a 10,000-lb sand-based roughing filter frequent cleaning by trained personnel. 1996, P. 30), researchers at Lawrence Berkeley National Laboratory in Calif., li- censed their redesigned UV Waterworks disinfection system to WaterHealth International in Napa, Calif. With an ex- clusive worldwide license (except in India, where it is sold by Urminus Industries Ltd. of Bombay), WaterHealth is selling production models in developing coun- tries including Mexico, Haiti, the Philippines, Uruguay, Brazil, Nepal and Bangladesh. Berkeley physicist Ashok Gadgil and his group invented the system in response to a 1993 Indian outbreak of cholera. Based on the initial field tests and with new support, the Berkeley researchers re-engineered With the UV disinfection system on the the system to be less costly outside kitchen wall, clean water and more compact, said becomes available at the sink inside. Gadgil. A field test of the Durban Metro Water plumbers and a new design is in progress at Berkeley lab researcher installed a the Lily of the Valley HIV- manufacturing prototype at an HIV Hospice in South Africa. hospice for a 1-year field test starting in August 1997. Courtesy of A. Gadgil. Other methods impractical The two most common water disinfection methods are boiling and chlorination. Chlorine treats a broader range of organisms than UV and offers residual protec- tion until it evaporates, but chlorination can be expen- Researchers hope to improve the water quality sive and requires skilled in developing communities permanently. The plastic exterior of the production maintenance as well as a Therefore, in addition to sampling the water, model protects it from the environment supply of potentially haz- field tests address social factors such as in hot as well as cold climates. ardous chlorine. Boiling community acceptance, education about WaterHealth is looking into field testing provides no residual pro- sanitary practices, and local maintenance and the unit in native communities in Alaska tection against recon- management. Courtesy of A. Gadgil. where clean unsalted water is scarce. tamination, such as from Courtesy of WaterHealth International. 24 BIOPMOTONICS INTERNATIONAL JULY/AUGUST 1998 SPECIAL DOUBLE ISSUE U.S.News DEC. 30, 1996-JAN. 6, 1997/$3.50 Sutlock97 20 WAYS TO SAVE THE WORLD ALSO Toxic Fame, Failed Predictions, Buzzwords and the Year in Pictures, 1996 53 0 71486 02239 8 KEEP ON SALE UNTIL JAN. 31, 1997 HE CARTH TIMES / UPINIUN NOVEMBER 1 15, 1997 EDITORIAL A test for market forces: Clean water and UV light THE EARTH BY PAULA DIPERNA The unit requires only 40 watts of electricity to light the needed UV bulb, which means the water unit can run on a ecently, at a resort hotel on a water-short car battery or bicycle-pump generator. Where even such R island, few people seemed concerned about rudimentary power sources are lacking, separate power water. The hotel went only so far as to packs can be added to the water unit to harness solar or discreetly place a small card near the sink that wind power, for $600 to $1,200 additional cost per unit, said, "Help us by keeping water use in mind." depending on local conditions. The power packs even Meanwhile, in the restaurant, eager waiters generate surplus power that could be put to other uses. kept topping up large glasses of iced drinking water This all means that about 1,000 people can have their almost the moment after a diner had taken a sip. Water daily water needs met, plus pick up some extra electrical shortages don't seem to mean a thing anywhere the power, for not more than $2,000 in initial investment, with affluent gather. very low maintenance thereafter for the 15-year life of the Yet severe water scarcities are among the most unit. This is a cost roughly equivalent to a 10-day stay for worrying trends for the future. The United Nations one person in the hotel where water conservation seemed Industrial Organization (UNIDO) suggests that 1995's a mere footnote. industrial water use could double by the year 2025, WaterHealth says the first UV units will be ready to causing a four-fold increase in the pollution load on the ship this fall, and it has begun to establish networks of world's fresh water. local retail distributors around the world, including micro- At the same time, water-use inefficiencies persist, enterprises using micro-credit loans. But what can insure despite trends toward privatizing water services, and the that the units will be priced at the retail level cheaply world's poor people still cannot imagine the day when enough to be accessible to the rural poor, yet high enough to return a profit to permit continued mass production? Will governments be sufficiently motivated to meet their people's water health needs to buy and install the units if a community is too poor itself to do so? Or will governments shun this too as "subsidy"? In short, will such an apparently appropriate and affordable technology get into the hands that need it most, especially since Gadgil himself is acutely mindful of the development needs of the poor. The UV technology involved has gone from concept to practice, production and international outreach in just a few years-nearly record time-presumably because its viability seems a given. Thus, this relatively simple and clean water will be readily available to them, let alone to inexpensive device offers a true chance for profitability be taken for granted. demands and human needs to be met together. The test An encouraging sign is emerging currently on the water will be as clear as water. front, as a new technology developed over three years by a research team headed by innovative physicist, Ashok J. Gadgil of the Lawrence Berkeley National Laboratory, THE EARTH TIMES moves toward mass commercial application and, one PUBLISHED BY THE EARTH TIMES FOCADATION hopes, closer to the people who need it most. A not-for-proft foundation duely cartified as ter-crempt Gadgil held audiences rapt in June 1996, at the Habitat under Section 501 (c) (3) of the us Internal Revenue Code Prancy Gupie President: Jon Quine, Counsel and Secretary: II conference in Istanbul, with his description of a gravity- Ranjil Sahni Treasurer, Auditors: Roserveig dk Maffia Inc. (New York) driven water purification unit that uses ultra-violet (UV) NEW York ADDRESS: 205 East and Street, Suite 1316, New York, NY 10017 light to remove bacteria and viruses from water to make it Tet 212-297-0488; Fax: 212-297-0566; E-MAlt: [email protected] safe to use and drink. The costs were below negligible- DAILY INTERNET EDITION: http://www.carthilmes.org roughly two cents per metric ton or about seven cents a year to disinfect one year's drinking supply for one adult. adgil's apparatus seemed to hold out a promising G solution so accessible and affordable, one would expect to soon find the UV units in every community lacking potable water around the world. Customers would hardly seem to be lacking. But, in a world focused on private sector forces as the solution for development, commercial viability of such new technologies has to be established, and customers must have enough money to buy. A small group of investors who had heard of Gadgil's work have formed a for-profit company, WaterHealth International, with an initial capitalization of US$300,000, and successfully negotiated a licensing and royalty agreement with the Livermore Laboratory for the rights to manufacture and market the UV water units worldwide, except in India, where a different firm was granted the rights. According to WaterHealth, a unit can purify water to meet the daily drinking and other potable water needs of 500 to 1,500 people in developing countries SACECS Newsletter of the South African Centre for Essential Community Services issue no. It mapril 1998 contents Seeking solutions The work of the South African We are particularly proud of the By continuing with the Centre for Essential Services solid relationships we have strengthening of collaboration (SACECS) has rapidly established with the MRC, with critical stakeholders, we developed since the Centre's WRC, FRD, CSIR, Umgeni hope to be able to more foundation in 1996 under a Water, Rand Water and the efficiently and effectively collaborative agreement between Department of Water Affairs and influence national and regional ESKOM and US-based EPRI. Forestry in addressing issues of government on social change mutual concern. SACECS endeavours to develop, and upliftment of communities. demonstrate and utilise pm appropriate technologies to Cynthia Motau, National Director support the needs of communities in meeting their environmental challenges by creating opportunities for economic growth, development and social well-being. This is the first issue of a quarterly newsletter planned by SACECS. Our objective is to continue to promote and market SACECS' activities and projects, and explore management strategies that will strengthen the synergy between ourselves, water utilities and the health care industries. SUCCESS 1 Issue 1 mechanical engineering Cleaning up with ultraviolet light Remote planetary explorer Re-engineering for remediation Sensors for manufacturing smaller chips Flexible robotic wrist Customizing Biomechanical Parts LTRAVIOLET LIGHT HAS a proven track record of along with 2,400 pounds of sulfur dioxide per day to U killing bacteria and viruses found in municipal neutralize the chlorine. wastewater. In addition, environmental con- CCCSD reconsidered its chlorination strategy in cerns over the use of chemical disinfectants, coupled 1990, when community groups expressed concern with improvements in ultraviolet-lighting technology, about the possible accidental discharge of chlorine gas have led to the development of UV systems that treat into the air. In addition, provisions of the Clear Air spent metalworking fluids in the industrialized world; Act required limiting worker exposure to chlorine disinfect drinking water in developing countries; and fumes, and provisions of the looming fire code speci- clean aquaculture water, ballast water, and hospital air fied the installation of an expensive leak-containment everywhere. system to prevent such discharges. Typically, chlorine gas or liquid is injected by a high- In 1991 CCCSD plant management compared the costs speed inductor directly into wastewater to kill bacteria of continuing to use chlorine treatment with those of before the water is discharged. "The main advantage three other disinfection strategies: hypochlorite, ozone, UV has over standard disinfection techniques is that the or UV treatment. Hypochlorite cost about twice as light-based system eliminates the transport and use of much as chlorine on an annualized basis and ozonation chlorine," said George Tchobanoglous, professor emeritus of civil and environ- mental engineering at the University of California, Davis. "Even though the water is dechlorinated by the addition of other chemical compounds such as sulfur di- oxide, residues of these toxic compounds remain in the water, which is a matter of increasing concern." Tchobanoglous chaired a committee of academic, industrial, and environmental consultants who drafted guidelines on UV disinfection for Califor- nia in 1994. Another factor leading municipalities to reconsider chlorination is its increased cost due to the national Uniform Fire Code adopted in 1993. This specifies double con- tainment of stored chlorine and chemical scrubbers in case of leaks-both of which are expensive propositions. "There are no residuals left by UV-light sys- tems, whose effectiveness has been improved with the development of more-intense ultra- violet lamps. Now, one lamp can do the Water authorities are replacing chlorination by using banks of UV lamps, shown here being cleaned of sediment, to disinfect municipal wastewater. work of 20," Tchobanoglous said. was even more expensive, but three UV systems were REPLACING CHLORINATION comparable to the cost of chlorination and dechlorina- Only about 5 percent of American wastewater is cur- tion. An additional factor favoring UV treatment was an rently treated by UV before being discharged, but the unused concrete denitrification channel in which lamps Electric Power Research Institute (EPRI) in Palo Alto, could be installed. Calif., expects that figure to grow to 25 percent within A large-scale pilot plant capable of treating less than 10 years. 1 million gallons per day was built on-site by Los Ange- The Central Contra Costa Sanitary District (CCCSD) les-based Montgomery Watson and CCCSD in 1992. It in Martinez, Calif., is an example of UV's growing ac- demonstrated that UV was just as effective as chlorina- ceptance by U.S. municipalities. The district's treatment tion in killing bacteria and slightly more effective in de- plant, located 45 miles from San Francisco, treats approx- stroying viruses found in the Martinez plant's wastewater. imately 40 million gallons of wastewater per day before It also showed the lamps would need to be cleaned of discharging it into Suisun Bay and San Francisco Bay. fouling every two to four weeks. The plant's old treatment system, dating from the early Montgomery Watson designed the UV system, which 1970s, involved adding 3,500 pounds of chlorine daily, was installed in October 1996. Water is piped to a treat- ment channel that is covered by a clear plastic lid to Triton Thalassic Technologies designed a specialized ultraviolet geometry, reduce algae growth. Eighteen banks of low-pressure gas combination, and fluid dynamics that enable its UV technology to emit a monochromatic wavelength that kills bacteria in machining fluids without mercury ultraviolet lamps made by Bailey-Fischer & damaging the fatty acids that provide the fluids' performance characteristics. Porter Co. in Warminster, Pa., line the sides of the chan- MECHANICAL 1997 83 Beams from these louvered UV lamps draw in tuberculosis germs by air convection, thus preventing the disease's spread in hospitals and homeless shelters. the ammonia produced by fish breeding. T'I is working pipe, and we can easily scale up the system for larger closely with the Biotechnology Center at the Universi- vessels." Ressler said. ty of Connecticut in Storrs, anticipating a state-funded SAVING LIVES IN DEVELOPING COUNTRIES project to adapt its UV technology to treating aquacul- ture water. Ressler said his company will be field-testing In developing nations, 400 children under five years old FASTAC in tilapia. flounder, and salmon aquaculture fa- die every hour from diarrheal diseases, including cholera cilities this fall. and typhoid. that are transmitted by contaminated drink- T³1 originally aimed its UV technology at dealing ing water. Although UV treatment can kill these water- with industrial-plant zebra mussel fouling and treating borne pathogens, such systems are often too expensive contaminated ballast water discharged by cargo ships for third-world villages. Scientists at the Lawrence and tankers. and it has continued to develop these ap- Berkeley National Laboratory in Berkeley, Calif., devel- plications. Discharged ballast water has introduced oped UV Waterworks. an inexpensive, low-maintenance nonindigenous species into countries, including the UV treatment system specifically geared for developing United States, where they have no natural enemies. As nations (see "Cleaning Water with Light." News & a result. these foreign creatures often proliferate to the Notes. August 1996). point where they pose an environmental and econom- The Berkeley design team was led by Ashok Gadgil, an ic problem. The best-known example is the zebra ASME member and a physicist at Berkeley. "There was a mussels that have clogged industrial and power-plant lot of mechanical engineering involved in designing the intakes along the Great Lakes (see "Power Plant Pest." UV Waterworks system." Gadgil said. "For example, we Input/Output. March 1991). performed radiometrics calculations to ensure that the T31 was first approached by its automotive client proper light intensity is maintained. We also analyzed the when it presented its UV technology as an alternative hydrodynamics of the flow to prevent a wide distribution to using chemical biocides to kill the zebra mussel at of residence time for water flowing under the lamp. This the Zebra Mussel Conference in February 1995. ac- ensures high efficiency." cording to Ressler. Since that time. a congressional UV Waterworks can be connected to the pumps com- task force supporting the National Invasive Species Act mon to most villages in developing countries in two and the United Nations' International Maritime Orga- ways. In the case of hand pumps. the unit is connected to nization have become interested in using FASTAC in a surge tank. typically holding 30 liters. that collects conjunction with prefiltration to kill virtually all the water from the pump. For electrical borehole pumps. the microorganisms in ballast water without using chemi- disinfecting unit is connected to a tank mounted on a cal biocides. small pedestal. Ressler's company is in the design phase. and is lab- Water from either tank enters a stainless-steel chamber, testing a FASTAC system to serve the typical commer- and is bathed by UV light at 254 nanometers-the opti- cial freighter plying the Pacific Ocean between the mum frequency for killing bacteria-emitted by a single United States and the Far East. "The prototype system 36-watt standard mercury-vapor lamp positioned above can treat the required 4.000-gallon-per-minute loading the water without contacting it. This eliminates the need and discharge flow rates through a 12-inch-diameter for and expense of the UV-transparent sleeve used on MECHANICAL ENGINEERING JULY 100/- 85 AIDS in Africa is a Serious Crisis But Opportunities Exist for Helping to Save Millions of Lives AIDS in sub-Saharan Africa is shattering families and communities. In many countries in southern Africa, between 16% (South Africa) and 26% (Zimbabwe) of the adult population (15 to 49) is already HIV+. UNAIDS has declared HIV/AIDS in Africa "the worst infectious disease catastrophe since the bubonic plague." In sub-Saharan Africa, each and every day more than 11,000 additional people become HIV+. In South Africa alone, at least 1,500 people a day become HIV+, 1,000 of whom are under the age of 20. 83% of all AIDS deaths to date, nearly 12 million people, have been in sub-Saharan Africa. There are over 5,500 AIDS related funerals a day in Africa. That number will rise to 13,000 a day by 2005. By 2010, more than 40 million children worldwide will be orphaned by AIDS; 95% in sub- Saharan Africa. AIDS is wiping out decades of progress on a host of development objectives in sub- Saharan Africa. According to US Census Bureau, AIDS has already reduced life expectancy Zimbabwe from 65 to 39 years, in Uganda from 54 to 43 years, and in Zambia from 56 to 37years. In the next few years, AIDS will reduce life expectancy in South Africa by a third, from 60 to 40 years. In the coming decade, AIDS will double infant mortality (infants under the age of 1) in many sub-Saharan Africa countries and triple child mortality (children ages 1 to 5). AIDS is not only causing unfathomable human suffering it is jeopardizing the economies, the stability, and civil society of many sub-Saharan African nations. AIDS is a trade and investment issue. At the recent meeting with African trade and finance ministers, Professor Jeffrey Sachs, director of the Harvard Institute for International Development, stated that, "a frontal attack on AIDS in Africa may now be the single most important strategy for economic development." According to The Economist, a recent study in Namibia estimated that AIDS cost the country almost 8% of GNP in 1996. Another analysis predicts that Kenya's GNP will be 14.5% smaller in 2005 than it would have been without AIDS, and the per capita income will be 10% lower. A report released by the World Bank last week states: "The question is, will this pandemic destroy the developing nations' hard earned economic gains or will governments get their act together in time? Clearly time is running out." AIDS has hit professionals hard in sub-Saharan Africa, particularly civil servants, engineers, teachers, miners, and military personnel. According to one study in Kigali, Rwanda, 34% of people with post-secondary education were HIV positive, compared to 18% of those with primary education, and civil servants were more than three times more likely to be HIV positive than farmers. Increased benefits and training costs, and disruption due to sick and bereavement leave are seriously affecting both the private and public sectors. Companies like British Petroleum and Barclay Bank told us that they are now hiring two employees for every one skilled job, assuming that one will die of AIDS. AIDS is a security issue. According to the Economist, "the estimated HIV prevalence in the seven armies embroiled in the Congo range from 50% for the Angolans to 80% in Zimbabweans". Recent reports confirm that 40% of the South African military is already HIV positive. US military officials have raised this as a serious stability concern. A South African anti-crime institute has linked the growing number of children orphaned by AIDS to future increases in crime and civil unrest. Without appropriate intervention, many of the 2 million children projected to be orphaned by AIDS in South Africa will raise themselves on the streets, often turning to crime, drugs, commercial sex, and gangs for survival. This not only effects social stability but also dramatically increases their risk of HIV. Determined leadership and partnerships have made, and are continuing to make, an extraordinary difference, saving millions of lives. Uganda has been the world leader in demonstrating that even a country with limited resources and low levels of literacy could turn the tide on a burgeoning epidemic. President Museveni demonstrated bold leadership early on, making every government ministry take the problem seriously, and develop and implement its own plan for reducing stigma and transmission, and caring for those who become sick. Uganda has created an enabling environment for donors, such as the US, to be active partners in the battle against AIDS. The US has invested $46 million in HIV prevention and care in Uganda (26% of all donor AIDS funding), and as a result, HIV rates have been slashed by more than half. Through stigma reduction, education, HIV counseling and testing, treatment of STDs, and community based HIV care and support, Uganda has begun to turn the tide. Countries such as Zambia, Malawi, Uganda, and Kenya have begun to develop initiatives to respond to the growing number of children orphaned by AIDS. In the longstanding African tradition, communities are finding creative ways to support the village in its efforts to raise its children, but the growing number of orphaned children already overwhelms many of these villages. Through micro-finance programs like FINCA (Foundation for International Community Assistance), women are receiving loans, starting small businesses, and with increased household incomes, taking in children orphaned by AIDS. With support of non-governmental organizations, communities are coming together to deal with school fees, nutritional assistance, immunization and oral hydration, counseling, and the range of other needs that arise for orphaned children. These efforts are low cost strategies designed to empower women, protect children, and support extended families and communities in carrying for their own. For a small fraction of the cost of one orphanage bed an entire community of vulnerable children can receive care. The problem is that only a very small number of children receive even this modest level of support. Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001a. fax Fax coversheet from Kenneth Bernard to Frank Loy, et al. [partial] [10 05/02/2000 P3/b(3) U.S.C. 424] (1 page) COLLECTION: Clinton Presidential Records National Security Council African Affairs (Byrne, Cathy/Dempsey, Nora/Battenfield, Patricia) OA/Box Number: [OA/ID 3078] FOLDER TITLE: Dempsey - AIDS [1] 2007-1550-F ke2005 RESTRICTION CODES Presidential Records Act - [44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. NATIONAL SECURITY COUNCIL NATIONAL From: Kenneth W. Bernard International Health Affairs SECURITY Phone: 202 456-9391, Fax: 202 456-9390 COUNCIL Date: May 2, 2000 Pages to follow: 15 17th & Penn, N.W. Washington, D.C. 20504 ADDRESSEES: Did you get a complete, Frank Loy, State 202 647-0753 Susan Rice, State 202 647-6301 clear transmission? If not, R.P. Eddy, USUN 212 415-4303 please call: Timothy Geithner, Treasury 202 622-0417 Alan Bowser, Commerce 202 482-5666 Chris Keenan at Mac DeShazer, Labor 202 693-4780 (202) 456-9394 David Satcher, HHS 202 690-6960 Sue Bailey, DOD 703 697-4197 P3/(b)(3) [001a] Barbara Turner, USAID 202 216-3235 Mark Scheider, Peace Corps 202 692-2101 Leon Fuerth, OVP 6-9500 delivered Robert Kyle, OMB 5-0345 Joseph Papovich, USTR 5-3891 Laura Efros, OSTP 6-6028 delivered Eric Schwartz, NSC 6-9140 delivered Gayle Smith/Nora Dempsey/INSC 6-9260 delivered PLEASE SEE ATTACHED DOCUMENTS! Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 001b. memo Kenneth Bernard and Sandra Thurman to Leon Fuerth, et al., re: P3/b(3) Interagency Working Group on the Global AIDS Crisis [partial] [10 U.S.C. 424] (0 page) COLLECTION: Clinton Presidential Records National Security Council African Affairs (Byrne, Cathy/Dempsey, Nora/Battenfield, Patricia) OA/Box Number: [OA/ID 3078] FOLDER TITLE: Dempsey - AIDS [1] 2007-1550-F ke2005 RESTRICTION CODES Presidential Records Act - [44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. NATIONAL SECURITY COUNCIL WASHINGTON, D.C. 20504 May 1, 2000 MEMORANDUM FOR MR. LEON FUERTH MR. MARK L. SCHNEIDER Assistant to the Vice Director President for National Peace Corps Security Affairs MR. MACARTHUR DESHAZER MR. FRANK E. LOY Associate Deputy Under Under Secretary for Gobal Secretary, Bureau of Affairs International Labor Affairs Department of State Department of Labor DR. SUSAN E. RICE DR. DAVID SATCHER Assistant Secretary for Assistant Secretary for Health African Affairs and Surgeon General Department of State Department of Health and Human Services RANDOLPH P. EDDY Senior Policy Advisor to the MS. BARBARA TURNER U.S. Representative to the Assistant Administrator United Nations Bureau for Global Programs, Field Support and Research MR. TIMOTHY GEITHNER Agency for International Under Secretary for Development International Affairs Department of the Treasury DR. SUE BAILEY P3/(b)(3) [001b] Assistant Secretary of Defense for Health Affairs Department of Defense MR. JOSEPH PAPOVICH Assistant USTR for Services, Investments and Intellectual Property Rights P3/(b)(3) U.S. Trade Representative MR. ROBERT D. KYLE MR. ALAN BOWSER Associate Director for Deputy Assistant Secretary for National Security and Basic Industries International Affairs Department of Commerce Office of Management and Budget FROM: Kenneth W. Bernard, National Security Council tibe Sandra Thurman, Office of National AIDS Policy 2 SUBJECT: Interagency Working Group on the Global AIDS Crisis Attached please find the final IWG document on expanding the U.S. role in controlling the international HIV/AIDS epidemic. It includes a summary list of "next steps," and is the result of two large interagency meetings in February and March, and five smaller issue-oriented subgroup sessions. The first two drafts of the document were circulated and attempts have been made to incorporate all suggested changes. Note that many of the suggestions are aspirational (therefore, some may require additional resources). While the IWG reached consensus that the ideas are good ones, agencies should be careful to adhere to departmental and Administration budget priorities and processes. The consensus document is not intended to be static, but rather an ongoing attempt to ramp up the USG response to the HIV/AIDS crisis. A number of issues and actions raised by the IWG will be further discussed in the Deputies and Principals Committee process. The IWG will meet again in June, prior to the International AIDS Conference in Durban, to document progress on each of the action items outlined in the consensus document. The lead agencies will coordinate input into this process. Please note that designation of agency "leads" (in parentheses after action items) is not intended to be exclusive. Those listed are requested to inform and coordinate with all relevant agencies. They will be asked to report to the IWG on USG agency-wide follow-up on progress on each action item. Attachment NATIONAL SECURITY COUNCIL WASHINGTON, D.C. 20504 April 28, 2000 U.S. GOVERNMENT USE ONLY INTERAGENCY WORKING GROUP CONSENSUS PAPER SUBJECT: Expanded United States Role in the Global HIV/AIDS Crisis Background Extent of the Problem: The human toll of AIDS is staggering. Fifty million people worldwide have been infected with the HIV virus; 33.6 million are now living with HIV/AIDS, and annual AIDS-related fatalities hit a record 2.6 million last year. Ninety-five percent of all cases are in the developing world. AIDS is now the leading cause of death in Africa and fourth in the world. In at least five African countries, over 20 percent of adults are HIV-positive. And the highest rates of new infections are often among young women who will soon be mothers. Other parts of the world are going down the same road as Africa. Infection rates in Asia are climbing rapidly, with several countries, especially India, on the brink of a large-scale expansion of the epidemic and needing to take action immediately to forestall the disaster that Africa has suffered. Parts of Latin America and the Caribbean also show high and rising rates of infection. And the former Soviet Union countries and Eastern Europe are vulnerable as well, with Russia experiencing the highest increase in infection rates in the world last year. AIDS as an economic and security issue: On January 10, under the leadership of Vice President Gore, the United Nations Security Council held a daylong session on the global threat posed by HIV/AIDS. This event was the first time the Security Council considered a health issue. The session reinforced what we have stated repeatedly, that AIDS is much more than a health or humanitarian issue - - it is a development issue, a trade issue, and a key stability and security issue. At the Security Council meeting, Secretary General Kofi Annan said that the "high rate of infection among police and armed 2 forces has left many African countries ill-equipped to face security threats." World Bank President James Wolfensohn added: "We're losing teachers faster than we can replace them. We're losing judges, lawyers, government officials, and persons in the military. Unless we act, there will surely be continued instability on the continent." USG International HIV/AIDS programs: The U.S. Government remains the world leader in responding to the global pandemic of AIDS. Current USG activities emphasize enhanced financial and political commitment, primary prevention, improving community and home based care and treatment, caring for children affected by HIV/AIDS, health infrastructure development, biomedical and behavioral research and training, and multisectoral efforts from the grass roots to the international level that reduce the impact of AIDS. Since 1986, USAID has dedicated over $1.2 billion to mitigate the epidemic. In FY 2000, we contributed four times as much as the next largest donor. But we will need to spend more -- much more. During the Security Council meeting, the Vice President outlined Phase II of our LIFE Initiative (Leadership and Investment in Fighting an Epidemic), the enhanced global AIDS effort which was launched last year with a budget amendment for a $100 million increase in our global AIDS program. Congress appropriated the funding; bringing our FY2000 global AIDS prevention and care program to $225 million nearly two thirds of which will go to Africa. The FY2001 budget includes an additional $100 million increase in our global AIDS effort (for a total of $325 million, excluding research) which will be targeted to: prevention; basic care and treatment; support for orphans; and health infrastructure development, and implemented by USAID, HHS (CDC), DOL and DOD. Many other agencies are contributing to the USG efforts. For example, in mobilizing human resources, the Peace Corps is training all new volunteers in HIV/AIDS prevention and education strategies. There are currently over 6000 Peace Corps volunteers globally, and more than 2,400 in Africa alone, many having primary assignments in HIV/AIDS work. In addition, a cadre of experienced "Crisis Corps Volunteers" is now being selected to work directly with HIV/AIDS in countries with high HIV/AIDS prevalence. And NIH is spending over $1.8 billion annually on AIDS research, with over $200 million each year in the search for a vaccine. 3 Extent of financial needs -- the example of Africa: UNAIDS estimates that it will take at least a $1 billion HIV prevention program in Africa to stem the rising tide of infection, including mother-to-child transmission. In 1999, all host governments and donors spent less than one third that amount on prevention, and very little in the military context. In addition, UNAIDS believes that it would cost an additional $1 billion to begin to bring basic medical care and treatment to the 24 million people in Africa already living with AIDS. At present, spending is less than one tenth that amount, with only 1-5 percent of those who are sick receiving even the most basic antibiotics and treatment for opportunistic infections. The total expenditure from all sources for HIV/AIDS prevention and care in the average sub-Saharan African country is only $5-20 million per year. The Interagency Process With the growing concern that the U.S. Government needed to further increase its efforts to deal with the AIDS crisis, an interagency working group (IWG) was convened under the co-chair of Sandra Thurman, Director, Office of National AIDS Policy (ONAP), and Kenneth Bernard, Special Advisor, National Security Council. The first meeting was held on February 8, 2000, and included representation from State (including USUN), USAID, Defense, Joint Staff, Treasury, Commerce, CIA, DOL, DIA, HHS (including NIH and CDC), Office of the Vice President, OMB, USTR, NEC, NSC and OSTP. Issue oriented IWG subgroups were formed to develop recommendations for enhanced USG action. They included 1) budget and legislation, 2) diplomacy and public awareness, 3) security, 4) economics, trade and finance, and 5) prevention and care. An ongoing process: This consensus document, drafted with input from all listed agencies and IWG subgroups (with the addition of Peace Corps), is not intended to be static, but rather an ongoing attempt to ramp up the USG response to the HIV/AIDS crisis. A number of the following issues and actions raised by the IWG will require further discussion at the departmental level as well as in the Deputies and Principals Committee process. The IWG, co-chaired by NSC and ONAP, will meet again in June, prior to the International AIDS Conference in Durban, to document progress on each of the action items outlined in the consensus document. It will then reconvene periodically 4 thereafter. Decisions on outstanding issues will be referred to Deputies or Principals as needed. Strategic framework for action To ensure that the United States continues its leadership role in combating HIV/AIDS, the IWG recommended that new USG activities be considered in the context of four overall objectives: Mobilizing an enhanced and coordinated United States Government response, and maximizing its leadership and effectiveness in the international battle to reduce HIV transmission and care for those who are sick. Enhancing political commitment by national governments to combat HIV/AIDS as a national and international priority, including mobilizing and leveraging increased internal national budget resources. Leveraging an enhanced response from other bilateral donors and multilateral institutions through a U.S.-lead international cooperative effort. Leveraging an enhanced response from the private sector in the United States, including corporations, foundations, religious institutions and non-governmental organizations. Issues and Actions (Note: Agencies in parentheses below are not the only agencies to be involved in listed issues or initiatives. They are, however, tasked with responsibility for convening discussion or planning groups as necessary and acting as rapporteurs for the specified issues at IWG meetings.) 1. Budget and legislation During this session of Congress, more than ten global AIDS initiatives have been introduced. Committees of jurisdiction in both chambers have favorably reported global AIDS legislation ranging from $510 million for FY2001 in the Senate to $1 billion over 5 years in the House. Ideas vary from enhancing existing bilateral efforts through USAID to creating a new multilateral AIDS Trust Fund at the World Bank. Currently, there seems to be considerable momentum on the Hill for moving a global AIDS 5 initiative either freestanding or as part of the Foreign Assistance or African Trade bills. Pending authorizing legislation should support or enhance the Administration's goal of securing an additional $100 million for the expansion of our current global AIDS initiative. Outcomes and strategic USG goals should define which legislative mechanisms and pending bills we should support. The Administration would proactively work with Congress to craft HIV/AIDS legislation that bolsters and helps launch international leadership initiatives and do not undermine other vital antipoverty/AIDS priorities such as HIPC. ONAP and WH legislative affairs will coordinate Administration response to the authorization bills, and take a proactive approach to the appropriations debate so as to maximize FY2001 funding of global AIDS activities. (ONAP) 2. Diplomacy and awareness The Department of State has aggressively increased its diplomatic outreach and education efforts, including the Secretary's 1999 International Response to HIV/AIDS and recent cables (State 34645, State 58033) to diplomatic posts calling for a dramatic increase in Embassy engagement with host countries. Strengthen U.S. diplomatic efforts Advance the concept, suggested by USUN, of having countries name Presidential Envoys for AIDS Control (PEACs). Each concerned country would name a senior envoy that would meet, debate, and help coordinate international efforts to deal with the thornier problems of the epidemic. Meetings of PEACs would provide a forum for discussion of issues needing international action, such as drug availability in poor countries, and making recommendations for innovative actions. (ONAP, State) Target USG efforts at the countries most at risk and target leadership in countries already heavily infected. (State, USAID) 6 Broaden diplomatic efforts to include regions other than Africa, including Asia and the Newly Independent States. (State) Highlight and actively implement in other at-risk countries the successful national AIDS programs in Uganda, Thailand and Senegal. (USAID, State) Develop a high-profile communications strategy for public diplomacy on HIV/AIDS control. (State) Develop at each Embassy a comprehensive HIV/AIDS action plan and integrate it into work and reporting requirements and resource allocation. (State) Establish required HIV/AIDS briefings for appropriate DOS Bureau personnel, including new Chiefs of Mission, Ambassadors, DCMs and others in Washington or in regional meetings. (State) Provide diplomatic posts with sufficient epidemiological and best-practices information through a dedicated DOS AIDS information officer, or through USAID missions. (State, USAID) Persuade foreign leaders of the profound effect of AIDS on their national security in terms of impact on political stability, economic growth, and civil society (NSC, State). Provide leaders with briefs and analyses on AIDS in their regions. (State, USAID, DOC) Issue new demarches on the security and health aspects of AIDS to be carried by the Ambassador to the head of state. (State) Develop innovative sustainable policies in partnership with other U.S. agencies, international organizations and entities. (State) Increase involvement with the U.S. and foreign business communities on HIV/AIDS, including information dissemination and worker education. (DOC, USTR, USAID) Work with the G-8, multilateral development banks and others to move basic health care, including AIDS prevention 7 and control, to the top of the finance and debt reduction agendas. (Treasury) Collaborate with WHO, UNAIDS and other UN agencies to develop more effective prevention, awareness and treatment programs. (HHS, USAID, State) Make international health and scientific collaboration on HIV/AIDS a priority in science and technology programs facilitated by the State Department. (State, HHS) 3. Security This year, the NIC, CIA and DIA have all produced excellent intelligence products on the impact of AIDS on the security, stability and economies of the hardest hit nations. DoD has prepared U.S. military education and training materials for HIV/AIDS prevention, some of which have been adapted for UN peacekeeping forces and given to USAID for review in FY2000. These materials could be adapted for African militaries in FY2001. Funding for expanding military-to-military training for HIV/AIDS prevention is in the President's FY 2001 budget request. In order to advance our operational goals regarding the public health and security aspects of the epidemic, each component of the intelligence community should work to increase collection of relevant data and provide periodic updates on the extent and impact of AIDS in their specific areas of responsibility. (CIA, NSC) DoD has shared U.S. military specific educational modules with USAID. These education modules will be adapted for specific cultural needs. DoD has begun limited, active involvement with HIV/AIDS prevention education and training with certain African militaries and should expand these efforts as soon as possible. (DoD) Secretary Cohen ensures appropriate and adequate HIV/AIDS prevention, education and training for the U.S. military. It is recommended that he should, as a priority, also reinforce the need for comparable HIV/AIDS prevention, education and training in international defense forces, and for UN peacekeeping forces. (DoD, State, USUN, NSC) 8 In addition to supporting the Administration's $10 million funding directly to DoD for this program in FY2001, DoD will work closely with DOS to identify FY2002-2007 International Military Education and Training (IMET) resource additions to fund (in the U.S.) HIV/AIDS professional education and prevention efforts. (DoD, State) All UN peacekeeping operations should effectively deal with AIDS education as an active and required responsibility. The U.S. should pursue negotiation of a UN Security Council Resolution on HIV/AIDS as a security issue, mandating HIV/AIDS prevention efforts for UN Peacekeepers. (State) 4. Economics, Trade and Finance Multilateral Support UNAIDS International Partnership Against AIDS in Africa and its efforts to dramatically increase political will and action by African governments. (USAID, State) Actively seek support for the President's proposal that the multilateral development banks dedicate an additional $400- $900 million in concessionary loans for basic health care and systems needed to expand immunization and prevent and treat infectious diseases, including AIDS. Actively encourage the EU and the G-7 to join in this request, and request all OECD donors to increase AIDS funding at each meeting and opportunity. (Treasury, NSC, OSTP) Actively encourage Highly Indebted Poor Countries (HIPC) to use, as a priority, their debt service savings for poverty reduction, including HIV/AIDS prevention and care activities. USAID and Treasury should help countries prepare Poverty Reduction Strategies to include AIDS control. High priority countries either approved or being considered include, Uganda, Mauritania, Mozambique, Benin, Tanzania, and Senegal. (Treasury) Follow-up the DOL/AFL-CIO Trade Unionist Summit to advance HIV prevention issues at the April meeting of the ICFTU in Durban, the SADC meeting and the 13th International AIDS Conference in Durban in July. (DOL) 9 Collaborate with the International Labor Organization to establish and enhance multisectoral framework for HIV/AIDS workplace education. (DOL) Bilateral Expand DOL involvement with AIDS prevention activities with other country labor unions, using $10 million FY 2001 funds. (DOL) Develop web sites containing workplace training manuals for HIV/AIDS to promote HIV/AIDS workplace education and prevention. (DOL, DOC) Establish a workplace HIV/AIDS education/training pilot project in Malawi during current fiscal year. (DOL) Private Sector Convene representatives from different industry sectors with government officials to discuss concrete suggestions to increase public/private cooperation in the battle against AIDS. Add NGOs as discussions progress. Do not limit to Africa. (OVP, DOC, HHS, Treasury) Expand the current USTR/HHS working group on trade and access to essential medicines. In discussions among health and trade agencies, generate a rational and forward-leaning approach to improving infrastructure and access to needed medications, while ensuring protection of intellectual property rights. Solicit input from NGOs and affected industries. Aim for mid-May delivery date for "next steps" in advance of the State visit of President Mbeki from South Africa. (ONAP, HHS, USTR, DOC, Treasury) Work with Congress to approve the Presidential initiative to provide a $1 billion tax credit for the sales of vaccines developed for HIV/AIDS (and other diseases such as TB and malaria that kill over 1 million annually). (Treasury, NSC, OMB) Increase outreach activities to foundations to raise funding of international AIDS activities. (USAID, ONAP, HHS) 10 Work with industry to develop multimedia commercials showcasing a unified public, private, NGO, international AIDS effort. Will motivate industry participation and raise public awareness. (DOC) Implement an outreach to industry for donations of multimedia equipment for communities and grass roots organizations to promote HIV/AIDS prevention and awareness. (DOC) Select a group of high-profile U.S. and foreign personalities for public service announcements related to global AIDS issues. (ONAP) Construct a Global AIDS Internet site, "Millennium Networking Against the Global HIV/AIDS Epidemic." (USAID, HHS) Sponsor video productions, in cooperation with U.S. national filmmakers, and with the partnership of African and other national governments. Emphasize real people in real situations. (State, USAID) Initiate an "adopt-a-school" program with NGOs, religious groups and the private sector, providing funds to keep AIDS orphans in school. (ONAP) 5. Prevention and Care and Research The U.S. Government is spending, in FY 2000, over $225 million overseas for HIV/AIDS prevention and care programs alone (excluding research funding). Current USG activities emphasize primary prevention, biomedical and behavior research and training, improving community and home based care. The following recommendations are for additional emphasis and action. Develop a working list of what governments and donors are spending in each country on HIV/AIDS prevention, treatment and care activities to focus new efforts on needs and gaps. (USAID) Restate the Administration commitment to develop a preventive HIV vaccine within the next 10 years. This should emphasize developing country (Africa, India, others) participation in the critical research. (HHS, USAID) 11 Initiate regular meetings co-chaired by USAID and HHS to coordinate specific strategies focusing on the delivery of prevention, medical treatment and care services to impacted communities. Expand activities and funding for treatment of opportunistic infections (such as TB and pneumonia), including increased availability of appropriate antibiotics and other medications. (USAID, HHS) USAID should be the lead agency for coordinating USG input into country-level HIV/AIDS activities, and will collaborate with HHS and the Department of State to develop a clear protocol to facilitate the entry of new USG partners into collaboration with individual country programs. Country-level coordination, especially where USAID or HHS do not have permanent staffs, should be part of the developed protocol. In situations where HHS/NIH are doing collaborative biomedical research, arrangements for adequate coordination with other USG agencies working in country must also be assured. (USAID, HHS) Quickly establish a Working Group, under the joint chair of HHS and USAID, to focus on the challenges of delivering services to reduce mother-to-infant HIV transmission. Issues include: increased access to accurate HIV testing and confidential counseling; the risk of breast feeding and safety of infant formula in low resource situations; efficacy and safety of short course anti-retroviral drugs such as Nevirapine and AZT, and concern that drug treatment may divert resources form other services. (HHS, USAID) Fully implement an initiative to train all 2,400 Peace Corps Volunteers in Africa in HIV/AIDS prevention and awareness techniques, and field teams of experienced former Peace Corps Volunteers to assist on critical AIDS projects. (Peace Corps) Highlight and actively implement in other countries the successful Peace Corps AIDS projects in Malawi, Thailand and Senegal. (Peace Corps) NIH, CDC and others should establish centers of excellence in international settings that will support basic research and long-term cohort studies; serve as locations for studies of efficacy of biomedical and behavioral prevention interventions, including Phase I, II, and III vaccine trials as well as trials of topical microbicides; function as training centers for investigators from throughout the region; 12 and provide bridges to services. The centers should provide an environment for the development of true and equal partnerships between the U.S. and foreign investigators. (HHS) Call for consistent Administration messages on the need to empower women to reduce their vulnerability. Consider a major initiative to accelerate microbicide development. (HHS, USAID, State) Call for the Administration to make a statement to more fully involve the faith communities, both here and abroad, with prevention efforts and patient care. (ONAP) Because global TB, now exacerbated by HIV/AIDS, is the leading cause of death in the developing world, pledge increasing support to the international "Stop TB" initiative. (HHS, USAID) Endorse community-based approaches to support children and their families affected by AID (especially avoiding dependence on orphanages). (ONAP, USAID, Peace Corps). Consult with Congress on extending the "notwithstanding" provisions of the Foreign Assistance Act, Section 522, (Child Survival, AIDS and other activities) to include an exemption from the "Buy America Act" (Section 604) to allow procurement of critical HIV/AIDS pharmaceuticals and other selected commodities. (OMB, USAID) USG Coordination of International AIDS Activities Commending the work of the Office of National AIDS Policy (ONAP) in our global efforts, the Interagency Working Group recommended that ONAP retain the USG focus for international HIV/AIDS coordination. However, that office currently has insufficient personnel resources to fully staff its international as well as domestic responsibilities. Therefore it is recommended that ONAP be expanded to include a Deputy for International Affairs to cover the broad coordination of USG activities related to the global epidemic. The Deputy Director for International Affairs, to complement ONAP's interagency responsibilities, would be designated to coordinate USG international activities for that office, and, in 13 doing so, maintain a close working relationship with National Security Council senior staff, especially the senior health advisor to the Assistant to the President for National Security Affairs. Nora worth passing to Sandy T ? (Believe we should not add to @Africa scheduling pile right now, but looks good) NATIONAL INSTITUTES OF HEALTH COMMITMENT TO INTERNATIONAL AIDS RESEARCH NIH AIDS Research Program and Budget The conduct of research is a critical component of a comprehensive strategy to improve the international response to HIV. Even resource-poor nations can make long-term commitments to participate in research, through collaboration with partners in industrialized nations. The National Institutes of Health (NIH) represents the largest single public investment in AIDS research in the world. It supports a comprehensive program of basic, clinical, and behavioral research on HIV infection and its associated opportunistic infections and malignancies. Half of the total $2 billion NIH AIDS research budget supports basic research that benefits all HIV-infected individuals, including those in developing countries. Of the remaining half, NIH conducts and supports AIDS research that has important specific international benefits. Some of this research is taking place in international research sites. NIH collaborates with UNAIDS, host country governments, and in-country scientists in prevention research and preparation for efficacy trials. Sites have been established in Uganda, South Africa, Haiti, Malawi, Thailand, India, Zimbabwe, Zambia, Trinidad and Tobago, Brazil, and Kenya. NIH will significantly increase its investments in this area in FY 2001. The major areas of the NIH AIDS research program of benefit to the international community include: Vaccine Research Development of Topical Microbicides Prevention of Disease Transmission and Disease Progression Research on Women and AIDS Prevention and Treatment of HIV Infection in Children Prevention and Treatment of Opportunistic Infections, including Tuberculosis Capacity Building and Training of Foreign Scientists Research Collaboration Private Sector/Foundation/NGO Support Vaccine Research The toll of the epidemic in developing countries where therapeutic and prevention interventions are unavailable or unaffordable, as well as in industrialized parts of the world, dictates the important emphasis on vaccine development. NIH spending for AIDS vaccine research has increased 100% since FY 1995. President's Vaccine Initiative: The President has made the discovery of an AIDS vaccine a national research priority. A safe and effective vaccine is the critical missing element in our armamentarium for the prevention of HIV and ultimate control of the pandemic, and remains one of the highest research priorities. A new Vaccine Research Center has been established at the NIH. G-8 Initiative: At the Summit meetings of the G-8 nations for the past two years, we have agreed to work to devote appropriate resources to the quest for an AIDS vaccine. NIH has also pledged to work with other G- 8 nations on vaccine research efforts. 1 In recognition of the need to develop vaccines that are efficacious against a variety of strains found around the world, NIH supports studies analyzing genetic and antigenic variation of HIV and targeted toward eliciting cross-reactive immune responses. Vaccine Clinical Trials: The NIH AIDS Vaccine Evaluation Group, consisting of 6 U.S. sites, is evaluating potential HIV vaccines in phase I and II clinical trials. To date, more than 46 trials with 24 different vaccine candidates and adjuvants have been conducted. In preparation for Phase III efficacy trials, NIH supports the HIV Vaccine Trials Network, a domestic and international network of sites that are currently identifying the cohorts of populations at risk for HIV infection and building the infrastructure necessary to conduct large-scale efficacy trials of potential HIV vaccine candidates when they become available. These efforts involve strengthening in-country research capacity. Awards will be made shortly, including sites in developing countries. The changes that have been implemented in this area over the past few years, and the scientific advances that have been achieved, have enormous potential significance, not only for AIDS but for other diseases as well, as progress made in the development of an AIDS vaccine will certainly have implications for vaccines against other life-threatening illnesses. Development of Topical Microbicides The development of safe, effective and acceptable topical microbicides is a global need to protect women around the world from sexual transmission of HIV infection. The Secretary has made this a high priority for U.S. government-supported research. NIH sponsors a comprehensive biomedical and behavioral program for the discovery, development, preclinical testing, and clinical evaluation of topical microbicides and other female-controlled barrier methods for prevention of HIV transmission. NIH plans to expand its Topical Microbicide Program Projects involving multidisciplinary research to develop and test new agents and will expand contracts and grants for developing and testing spermicidal and non-spermicidal microbicides and other female-controlled barrier methods. Prevention of Disease Transmission and Disease Progression NIH-sponsored programs target studies on factors related to transmission of HIV and the pathogenic mechanisms associated with HIV disease progression through a number of studies in Africa, Asia, and Latin America. These studies focus on the biologic determinants of infectiousness and susceptibility. NIH sponsors an extensive biomedical and behavioral research program for the discovery, development, preclinical testing, and clinical evaluation of interventions to prevent HIV transmission, slow disease progression, and limit disease mortality. These intervention programs include the development of topical microbicides and other barrier methods, sexual and drug-using behavioral interventions, strategies to reduce perinatal transmission, and prevention of sexually transmitted diseases. The Prevention Trials Network is designed to conduct research on promising and innovative biomedical/behavioral strategies for the prevention or reduction of HIV transmission among at risk adult and infant populations. The research will include: (1) evaluation of a broad range of interventions designed to reduce adult and perinatal transmission of HIV; (2) basic laboratory studies which address viral and host factors related to risk of transmission, mechanisms of transmission and/or modes of action of successful prevention strategies; and (3) testing of microbicides. The network will include sites in developing nations. 2 Blood safety: In FY 2001, NIH will initiate a new program targeting the development and evaluation of effective, low cost, and reliable assay systems and inactivation processes to improve the safety of blood supplies in low resource, developing countries. Research on Women and AIDS A number of studies specifically examine complications of HIV disease that are unique to or more prevalent in women than in men. A critical area of concern is the impact of HIV on cervical cancer, as co-infection with human papilloma virus (HPV) is common in HIV-infected women. For example, a study in Africa is examining the natural history of cervical neoplasia in women infected with HIV-1 and HIV-1 and the role of HPV as a risk factor. An NIH multi-site international trial is investigating whether women who use hormonal contraceptives are at increase risk for sexual acquisition of HIV. Other studies are planned to examine the possible effects of hormones on infectiousness and disease progression. Prevention and Treatment of HIV Infection in Children Preventing transmission from HIV-infected mother to child is a priority of NIH intervention research. Initiation of treatment with zidovudine prior to birth, during delivery, and to the infant has significantly reduced the incidence of maternal-fetal HIV transmission in the United States. However, this protocol is not easily applied in developing countries because of cost factors and lack of health care infrastructure. Simpler and less expensive antiretroviral regimens for interruption of vertical transmission are being tested by NIH. To reduce transmission further, NIH research is pursuing studies to better understand the timing, mechanisms, and risk factors of perinatal transmission; whether specific strains are more likely transmitted; and the role of co-infection and other factors. Nevirapine Study: Clinical findings from an NIH trial in Uganda demonstrated that a single oral dose of nevirapine at the onset of labor to the HIV-infected woman and a single dose of oral nevirapine to her infant within 72 hours of birth reduced the risk of maternal-infant HIV transmission by nearly 50 percent. This simplified, low-cost regimen ($4) has significant international implications, since it may be a viable way of decreasing perinatal transmission in developing nations. Breast Feeding: A recent NIH-sponsored study showed that risk of HIV transmission through breast feeding is highest during the first few months of life. This finding and other ongoing studies will provide important information on the timing, risk factors, and potential approaches to block this mode of HIV transmission. Caesarean Sections: While initial studies have demonstrated the potential benefits of caesarean sections in reducing the risk of perinatal transmission, further studies are needed to assess the benefits against the risk of these surgical procedures on the infected woman and the potential applicability of this procedure in developing nations. Prevention and Treatment of Opportunistic Infections Tuberculosis (TB) represents the most common human infection in the world and is the attributable cause of one-third of all adult deaths in developing nations. HIV infection confers the greatest known risk for the development of TB, both the reactivation of latent infection and progression to primary disease, and UNAIDS estimates that approximately 30% of all AIDS deaths result directly from tuberculosis. Particularly ominous is the emergence of multidrug resistance. 3 In collaboration with the government of Uganda, NIH has made significant progress toward practical and affordable prevention measures to reduce the burden of tuberculosis. NIH-supported scientists in Thailand are studying risk factors for infection with Penicillium marneffei, a newly-described fungal infection that is the major OI in Thailand and potentially in other Asian nations. Capacity Building, Training of Scientists an Information Dissemination It is critical to the success of international studies that foreign scientists be full and equal partners in the design and conduct of collaborative studies and that they have full responsibility for the conduct of studies in-country. To help build capacity in developing countries, the NIH funds the AIDS International Training and Research Program (AITRP). The AITRP provides research training to foreign scientists through grants to U.S. universities. The program has provided training in the U.S. for scientists from developing countries in Africa, Asia, and Latin America, and training courses have been conducted in 60 countries. Pilot studies will be launched in FY 2000 to reduce HIV transmission through improving the blood supply in developing nations. NIH-supported HIV-related research helps to build laboratory capacity in developing countries where the research is conducted through purchase of laboratory equipment and transfer of research technology. The translation of research results into effective prevention programs and improved patient care is a high priority. NIH is continuing efforts to assure that research results relate to the cultural, social, and economic contexts of developing countries. Research Collaboration NIH has established the International AIDS Research Collaborating Committee. The goal of the Committee is to assist in (1) enhancing and promoting international collaboration in HIV research; (2) developing a coordinated international HIV research effort, including biomedical, behavioral, and social science studies; and (3) providing a forum for international exchange. Its membership includes the NIH, other government agencies and departments that conduct and support international research on HIV/AIDS, agencies involved in the implementation and dissemination of the results of such research, and international organizations such as UNAIDS and the World Bank. The development of international collaborations for tracking the natural history and epidemiology of infectious diseases and for obtaining and identifying variants of infectious agents from different geographic regions helped expedite research on AIDS. This experience, and the collaborations established, will be of great value as new epidemic diseases emerge in the future. 4 TO Be Released after Find Deaft 26/Aan 800 pm January 27, 2000 President Clinton Unveils Millennium Initiative to Promote Delivery of Existing Vaccines in Developing Countries and Accelerate Development of New Vaccines In his State of the Union address, President Clinton will call for concerted international action to combat infectious diseases in developing countries. These diseases cause almost half of all deaths worldwide of people under age 45, killing over eight million children each year and orphaning millions more. The President committed the United States to addressing this terrible problem in his September speech to the United Nations General Assembly. Now the President is asking for foundations, pharmaceutical companies, international agencies, and other governments to join us in this task, and he is announcing these specific elements of his Millennium Initiative: A new financial commitment to purchase and deliver existing vaccines in poor countries. As Vice President Gore told the U. N. Security Council earlier this month, doesa ct registrot yes the Administration's FY 2001 budget will include a proposed $50 million contribution to the vaccine purchase fund of the Global Alliance for Vaccines and sill inc Carpon) Immunization (GAVI). Davos speech. 5-10% of (DA money. Increased investments in health in developing countries. The President is calling on the World Bank and other multilateral development banks to dedicate an additional a way to $400 million to $900 million annually of their low-interest-rate loans to expand ect around immunization, prevent and treat infectious diseases, and build effective delivery drings ing days on Countri cc which systems for other basic health services. These investments are as central to economic don progress as investments in education and physical infrastructure, and they would build on the new focus on basic health services that we have supported as part of the Highly Leach: billions Indebted Poor Countries (HIPC) debt initiative. This proposed shift in existing resources bill IDA loars does not require additional U.S. budget expenditures. for AIDS A significant increase in basic research on diseases that affect developing nations. The Administration's FY 2001 budget for the National Institutes of Health includes a sharp step-up in research critical to the development of vaccines for malaria, tuberculosis, and HIV/AIDS. pharmacential A new tax credit for sales of vaccines for malaria, tuberculosis, and HIV/AIDS to thing only + bioth chipanes accelerate the invention and production of these vaccines. Because developing Stemm of Billion countries often cannot afford to buy vaccines, the market provides little incentive for me pharmaceutical companies to develop vaccines for diseases that disproportionately affect dollar credit. tax those countries. This tax credit would provide such an incentive, because every dollar paid by a qualifying organization to buy a qualifying vaccine would be matched by a Vanyove anyo ve or who dollar of tax credits - representing up to $1 billion of additional funding for future vaccine purchases. The President is calling on other governments to make similar to purchase commitments, so that we can ensure a future market for these critically needed vaccines. a or as NGO Jeff Sach Gentrer@ came no of this Treasury SUMMERS approved his. Tim POLICY RATIONALE AND ADDITIONAL EXPLANATION Infectious Diseases Pose a Mounting Social and Economic Burden on Developing Countries - And a Threat to Our Health As Well. More than eight million children die each year of centuries-old diseases like malaria, tuberculosis, and respiratory and diarrheal diseases. Deaths from the modern scourge of AIDS are climbing rapidly. Altogether, as many children die of infectious diseases each year as the total number of combatants who perished in World War I. In an interconnected and highly mobile world, health crises in other countries are a threat to everyone. We have seen this with HIV/AIDS, with the resurfacing of tuberculosis, and with the outbreak last year of West Nile encephalitis in New York. According to the Global Health Council, during the past 50 years, at least five times as many Americans have died from communicable diseases that have come from the developing world than have died in military conflicts. Vaccines Are One of the Most Cost-Effective Ways to Improve the Well-Being and Productivity of the Poorest Countries - And Medicines and Other Basic Health Services Are a Necessary Complement. It costs about $17 to immunize a child, but millions of children die each year of diseases that could be prevented by existing vaccines. Indeed, children in developing nations are 10 times more likely to die of a vaccine-preventable disease than children in developed nations. And these tragedies occur in spite of the enormous efforts of UNICEF and others to vaccinate children, which save 3 million lives each year. Highly effective vaccines do not yet exist for malaria, TB and AIDS, which take over 5 million lives each year. But developed nations have the scientific and technological capacity to make new vaccines possible. For example, recent work on genetic sequencing, including the human genome, will open vast possibilities. Another health investment with very high returns is simple preventive and curative services. Providing this basic health care together with vaccines would save millions of lives each year. A $50 Million Contribution to GAVI to Buy Vaccines For Children - Which Will Save Lives Now and Create Confidence that a Market for New Vaccines Will Exist in the Future. GAVI, the Global Alliance for Vaccines and Immunization, was formed as a collaborative effort of UNICEF, the World Health Organization (WHO), the World Bank, private foundations, bilateral aid agencies (including the U.S. Agency for International Development), industry representatives, and developing countries. GAVI established the "Global Fund for Children's Vaccines" with an initial grant of $750 million over 5 2 years from the Bill and Melinda Gates Foundation. The formal launch of GAVI, and the official announcement of the Gates gift, will occur shortly in Davos, Switzerland. A U.S. contribution will help to purchase vaccines for Hepatitis B, Haemophilus Influenzae B (Hib), and Yellow Fever, along with related safe delivery equipment such as auto-destruct syringes. To ensure that GAVI's vaccine purchases complement, rather than replace, existing vaccination efforts, they will be conditional on a country achieving 50 percent coverage of the DTP (diptheria-tetanus-pertussis) vaccine, which is included along with measles and polio in the existing EPI (Expanded Program for Immunization). A U.S. contribution will hopefully catalyze significant contributions from other countries and foundations. It will also add crucial credibility to the international community's commitment to provide a market for new vaccines when they are developed. We Must Shift Existing International Resources Toward Building Health Infrastructure in Poor Countries That Can Deliver Vaccines and Medicines and Provide Essential Basic Health Services. The World Bank and other multilateral development banks (MDBs, such as the African Development Fund) lend money on highly favorable terms to the world's poorest countries. Today, roughly $1 billion to $1-1/2 billion of this so-called "concessional funding" is devoted to health care each year. The Administration proposes to increase that amount by $400 million to $900 million per year, with a focus on: immunization; prevention of diseases using basic measures such as information and condoms for AIDS, treated bed nets for malaria, and stronger systems for containing TB; treatment of diseases, including common respiratory and diarrheal infections; and more effective provision of basic health care. The Administration is exploring ways to use the HIPC debt reform to support this part of the Millennium Initiative. One possibility is to make an increase in vaccination rates one of the performance targets monitored in the HIPC progress reports. This could be accompanied by debtor countries' agreements to include specific improvements in vaccine delivery systems as priority uses of debt relief proceeds. We also expect that all Poverty Reduction Strategy Papers that are prepared for HIPC candidates will discuss the adequacy of budget resources and suggested policy reforms devoted to basic health care. This re-direction of resources supports the Administration's overall strategy for global development, which emphasizes poverty reduction and gives a central role to "global public goods" - like health or the environment - in which positive actions taken in one country benefit other countries as well. To meet this objective, these funds should not come from spending on other basic social programs, such as education and health care. 3 This aspect of the Millennium Initiative does not require a new budgetary commitment by the United States (or other donor countries). However, the U.S. ability to influence the direction of MDB lending and the use of HIPC proceeds depends crucially on meeting our existing commitments to these aid programs. We will work with other G- 8 finance and development ministries to refine this proposal. A conservative estimate suggests that if basic health care including immunization were made broadly available, up to 2 million children's lives could be saved each year. Higher Funding for Basic Scientific Research Through the National Institutes of Health (NIH) and Elsewhere Will Hasten the Development of Vaccines for Malaria, TB, and AIDS. The Administration's FY 2001 budget for NIH includes a significant increase in research critical to creating vaccines for these diseases. For malaria and TB, this increase will build on recent advances in the genetic sequencing of these diseases, which have set the stage for major breakthroughs in vaccine development. Funding for NIH malaria vaccine research will increase by 20 percent over the FY 2000 level. Future research will range from pre-clinical studies aimed at improving our understanding of the malaria parasite, through the development of vaccine candidates, to clinical trials judging vaccine efficacy and safety. NIH will also expand its collaboration with scientists in malaria-endemic regions, especially in Africa, to strengthen those regions' capacity for conducting clinical trials of malaria vaccines in the future. NIH research on a tuberculosis vaccine will receive 50 percent more funding than in FY 2000 and nearly double the FY 1999 level. NIH will focus on studying the body's defense mechanisms against TB, and developing and studying TB vaccine candidates. Through its Tuberculosis Research Unit, NIH supports an international multi-disciplinary team to translate advances in basic research into new tools for fighting TB. NIH funding for AIDS vaccine research will increase substantially in FY 2001 and will have more than doubled since FY 1997. These additional resources will allow NIH to accelerate basic research on developing vaccine candidates and to significantly expand testing of potential vaccine candidates in both developing and developed countries. The new Vaccine Research Center on the NIH campus, which will be occupied this summer, will receive a sizeable increase in funding for the development and pre-clinical testing of HIV vaccine candidates. The Administration is providing strong support for the path-breaking research on infectious diseases being conducted by U.S. military scientists, including the opening (in October 1999) of the Walter Reed Army Institute of Research/Naval Medical Research Center. Working in close collaboration with scientists worldwide, military scientists have developed and tested successful vaccines against Japanese encephalitis and hepatitis A - 4 and they are working to create vaccines and medicines to protect service people, travelers, and millions of others from malaria, HIV/AIDS, and other infectious diseases. A New Tax Credit Would Effectively Provide Up to $1 Billion for Future Vaccine Purchases, Speeding the Invention and Production of New Vaccines. Current tax law provides substantial incentives for pharmaceutical research and development, including the research and experimentation (R&E) tax credit, the orphan drug tax credit, and an enhanced deduction for charitable contributions of certain products. Nonetheless, pharmaceutical companies may be reluctant to invest in developing vaccines for diseases that primarily afflict people in poor countries, because little or no paying market exists in those countries. Under the proposal, the seller of a qualified vaccine could claim a tax credit equal to 100 percent of the amount paid by a qualifying organization that received a "credit allocation" by the U.S. Agency for International Development (AID). The tax credit would match the qualified organizations' expenditures dollar-for-dollar, thereby doubling their purchasing power. A qualifying vaccine would be a new vaccine that received FDA approval for use against malaria, tuberculosis, HIV/AIDS, or any infectious disease that causes over 1 million deaths annually worldwide. For 2002 through 2010, AID could designate up to $1 billion of vaccine sales as eligible for the credit. This tax credit would be limited to new vaccines developed to fight these terrible diseases. The credit would provide a specific and credible commitment to purchase future vaccines at reasonable prices. Together with similar commitments from foundations and other governments, it would provide a critical and powerful incentive to accelerate vaccine research and development. 5 1DA acct. 10A Loans T prevente Leach will. + infresturature Seth Bukely Eye Abby. expanding HIPC. Baul. + Kerflnffle. AFRICARE 1/2 sudget Cant. has Ahice- almost Run 13 going to Se he chain of me Puedents ALAS cancil. Dellar 06/05/00 MON 12:08 FAX AIDS POLICY 001 OFFICE OF NATIONAL AIDS POLICY EXECUTIVE OFFICE OF THE PRESIDENT THE WHITE HOUSE FACSIMILE TRANSMITTAL SHEET TO: Nora FROM: Cheryl COMPANY: DATE: FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 6-9260 3 PHONE NUMBER: RR: URGENT FOR REVIEW PLEASE COMMENT PLEASE REPLY PLEASE RECYCLE NOTES/COMMENTS: Hi Nora- Sandy wanted your thoughts on this. Dls. call me when you have a Minute. Thanks! gagle - - I told ONAP just to have the Cheryl (6-2959 a regional A.I.D. person (who work on, on AIDS) to look into this 736 Jackson Place ) Washington, DC 20503 (202) 456-2437 -N, (202) 456-2438 (fax) 06/05/00 MON 12:11 FAX AIDS POLICY 5 001 Note the Logo JC WILSON IV INTERNATIONAL Coool, no? (I'm sure he ENTURES CORP. thinks so! ) AMBASSADOR JOSEPH C. WILSON IV May 3, 2000 Ms Sandra Thurman Director, Office of National AIDS Policy The White House 1600 Pennsylvania Ave. NW Washington DC, 20500 Dear Sandy, I was heartened to read about the decision to declare AIDS a threat to the United States National Security. Congratulations on everything you have done to focus attention on this serious issue. After close to twenty-five years in Africa and working on African Affairs, including with Jonathan Mann when he was in Kinshasa, I know, and have reported on, the enormous devastation wreaked on African societies by the disease. While many millions have already died or will die, it is never too late to fight for future generations I would like to be helpful in that fight, having lost too many African friends to AIDS. When I was in Gabon, Central Africa as U.S. Ambassador, I tried to interest CDC and NIH in a world class medical research center in Franceville, constructed and staffed by international experts for the purpose of studying low fertility rates in Central Africa, and especially Gabon. The center, called the "Centre International de Recherche Medicale de Franceville" (CIRMF), also studied Hepatitis C, Ebola, Malaria and of course, AIDS. There were exchanges with but funding constraints and other higher priorities limited them, and they may have been phased since my departure in 1995. Gabonese President Omar Bongo called me yesterday morning to support the President's announcement and offered to put CIRMF at the disposal of efforts learn more about, and to find a cure for, HIV/AIDS. I was impressed by his willingness to step forward on such a sensitive issue in Africa and I promised to do what I could to make the offer known to the appropriate American authorities, even though I am no longer in government. President Bongo will be meeting with the American Ambassador within the next few days to convey officially his offer, but I wanted to make you aware of his pledge in the hopes that you will find a way to take advantage of his initiative. 1717 Pennsylvania Avenue, NW. Suice 300. Washington, DC 20006 Telephone 202.887.6171 Facsimile 202.887.6786 Cellular 202.256.0536 E-Mail [email protected] 002 06/05/00 MON 12:09 FAX AIDS POLICY It is important to support African leadership on the HIV/AIDS, and to encourage African participation in the search for a cure. It is also important, as we have seen from the Mbeki letter, that there be constant dialogue between our scientists and politicians to ensure common understanding of the threat we all face. I hope that the U.S. government will respond positively to President Bongo's offer. We need all the help we can get. Please do not hesitate to contact me if I can be of assistance. Sincerely yours, and warmest regards, Joe Joseph C. Wilson, IV you are a the herome an this! VO you. is using Denolvary is a rish Tenible pen. Flowed elution cand Reprom is a manfactured civin I FES SENSITIVE BUT UNCLASSIFIED DRAFT June 2, 2000 INFORMATION DECLASSIFIED MEMORANDUM FOR SECRETARY SHALALA PER E.O. 13526 SANDRA THURMAN 2017-0739-m (1.94) KBH 8/19/2022 FROM: KENNETH BERNARD SUBJECT: French Proposal for a Conference on Access to HIV/AIDS Drugs Background: The French Government has been pushing for a tripartite conference on "Access to HIV/AIDS Drugs" as a way to "improve access to the latest treatments for infected populations in the South." They originally wanted this French- hosted event to be held in a Francophone African country and include government and NGO representatives from donor and developing countries as well as the pharmaceutical industry. After much acrimonious discussion at the UNAIDS Program Coordinating Board last week, we understand they may be reformulating their proposal. The French are considering the whether the meeting to discuss drug access be broadened to include "access to care," and whether it would be done under UN auspices. This meeting is a very important diplomatic goal for France. It will be a focus during their term in the Presidency of the EU this year. France's Ambassadors in New York and Washington as well as its Development and Health Ministers have all lobbied for the U.S. to sign-on to the idea as cosponsors. Dr. Michel Lavollay from the French Embassy in Washington is working full time to move the meeting concept forward. France likely will try to get both the International AIDS Conference in Durban and the G-8 Summit to endorse the meeting. Other country views: At the recent UNAIDS Board meeting in Geneva, Germany, Norway, Finland, and especially Sweden and South Africa (speaking for the SADC) vehemently opposed the French conference proposal, arguing that it was premature and too focused on drugs and not on important infrastructure and the continuum of care issues. If the meeting were to be done they argued, it should be within the UN system. They proposed a "contact group" of governments and NGOs convened by UNAIDS and CONFIDENTIAL SENSITIVE BUT UNCLASSIFIED 2 its Cosponsors, to deal more broadly with care, drug access, and infrastructure as an alternative to the French proposal. U.S. Position: In numerous working level discussions with the French, we have been very cautious about support for a meeting to deal specifically with "access to HIV/AIDS drugs," asking for more information without stating we would either fully support or formally object to the meeting. However, USG does support, and is working for, substantially increased emphasis on care and treatment (including pharmaceutical access) to complement prevention activities in developing countries. While the proposed meeting could potentially have some utility, we agree with the UNAIDS Board discussion that before we have a global session dedicated to finding solutions to HIV/AIDS care issues, there should be regional buy-in and preparatory meetings to define questions, goals and solutions. If a conference is held, it could be led by the French, but it would be best done under the auspices of UNAIDS and its Cosponsors. Talking Points (for the French MOH) We appreciate France's interest in dealing with the critical issue of care and treatment of HIV/AIDS - a sector that has been somewhat neglected in our focus on prevention. Drug availability and affordability are a critical components of providing care for those with HIV/AIDS, but must be viewed in the broader context of health infrastructure including HIV counseling and testing, provision of palliative and basic medical care including treatment of opportunistic infections like TB, support of community based clinics and training of health care workers. Any proposed Conference would have to include the broad range of care issues and be well coordinated with all interested parties. It would be difficult to see how that could be done before next year. We would also want to see the context and plans for a broadened conference before indicating our level of support. What do the French think of suggestions at the UNAIDS Program Coordinating Board by the Swedes and South Africans for modifying the French Conference idea - moving it to a UN institution? And the idea of a more permanent "contact group" to grapple with the drug issues? SENSITIVE BUT UNCLASSIFIED SENSITIVE BUT UNCLASSIFIED 3 We would be interested to know how you will respond to what appears to be a strong negative reaction to the conference by the South Africans [NB. who were speaking also for the Southern African Development Committee - SADC]. We are encouraged by the recent announcement by five major pharmaceutical companies to begin negotiations with developing countries to work out price structures that will make anti- retrovirals more affordable to those who need them. President Clinton recently signed an Executive Order allowing African countries to more easily obtain needed pharmaceuticals. The Order states that the US will not object to parallel importing or compulsory licensing of needed HIV/AIDS drugs, as long as the country follows TRIPS guidelines. The biggest need (for both prevention and care) in Africa right now is funding. there is a $2.5 billion annual gap between resources and needs. We are planning to call on the G-8 in Okinawa to redouble investments in international AIDS activities. SENSITIVE BUT UNCLASSIFIED 001 05/24/00 WED 13:12 FAX 202 647 9959 EUR ERA STATE NORA NAME AGENCY PHONE FAX GAYLE Alex Ross USAID 219-0476 219-0507 Mary Knox USAID 712-0978 216-3394 Sandy Thurman ONAP 456-2959 456-2439 Nora Dempsey NSC 456-9261 456-9260 Ken Bernard NSC 456-9298 456-9390 Laura Efros NSC 456-6065 456-6028 Joyce Holfeld USAID 712-4727 216-3394 Hal Shapiro NEC 456-5905 456-2223 Hoyt Yee NSC 456-9156 456-9150 Alicia Robinson DOC 482-5418 482-5198 Jason Buntin STR 395-9564 395-3974 Donna DiPaola STR 395-6864 395-3891 Barbara Holloway TREAS 622-0098 622-0218 Amar Bhat NIH 301-496-4784 301-480-3414 Sharon Hyrnkow NIH 301-496-1415 301-402-2173 Total pages - 4 Attached is the latest negotiated version of the text of the joint statement. It was shared with the EU on May 23. The EU has now posted this draft for comment with its member states and has given them until May 25, 5 PM Brussels time, to make comments. We have proposed that there will be a telephone conference at 10 AM on Friday to try to close any differences on text. Ken Bernard, Laura Efros, and Dick Morford will be in the chair. (This time works for the EU but has not been confirmed.) I must have any comments and final suggestions by 5PM on Thursday. We can then raise them with the EU in the audio conference. If you are interested in attending please me know. Thanks Ray Walser Tel-202- 647-1605 Fax - 202-647-9959 05/24/00 WED 13:13 FAX 202 647 9959 EUR ERA STATE 002 U.S.-EU Statement on the Expanding Threat of HIV/AIDS, Malaria and Tuberculosis in Africa May 24, 2000 (Please discard previous texts) Few challenges are more profoundly disturbing or more far-reaching than the collective threat posed to the citizens of Africa by three major infectious diseases: HIV/AIDS, tuberculosis and malaria. While the scope of the threat is global, Africa bears a disproportionate share of the suffering caused by these diseases. This year alone, HIV/AIDS will claim more than two million victims in Africa while more than a million lives will be lost to malaria and tuberculosis. The devastating effect of these diseases reverses decades of development and robs an entire generation, especially those caught in the trap of poverty, of hope for a better future. This health crisis in much of Africa deepens the vicious cycle of disease and despair, erodes security and undermines social and economic development and poverty reduction. We, the U.S. and EU, reiterate our commitment to combat HIV/AIDS, tuberculosis and malaria. Together with other countries and international organizations, we are already making a major effort. But the scale of the problem requires new mechanisms to mobilize international opinion and resources and to take appropriate actions to assist African countries. We welcome the work done in the UN Security Council during the January 2000 U.S. Presidency. In the Cairo Declaration and Action Plan of April 2000, the EU and African leaders pledged their commitment to pursue further action in this field. The renewal of the ACP-EU Partnership Agreement in June 2000 also highlights the need to work with African, Caribbean and Pacific Partners on a comprehensive approach in the context of poverty reduction. We are looking forward to G-8 initiatives on infectious diseases and poverty at the upcoming Summit in Okinawa. Today, at the EU-US Summit, we agreed to join forces and look at new mechanisms and partnerships in response to the threats posed by HIV/AIDS, malaria and tuberculosis. These will become part of our global agenda. We will work together to advance the following objectives: International partnerships 05/24/00 WED 13:13 FAX 202 647 9959 EUR ERA STATE 003 The EU and the US call for commitment and leadership to control malaria and tuberculosis and to combat HIV/AIDS in Africa. We welcome initiatives aimed at developing international partnerships with the WHO, UNAIDS and other UN agencies, the donor community, governments in developed as well as developing countries, the pharmaceutical industry and civil society in order to find ways to encourage new international responses and sustain successful national health strategies and improve access to drugs. We recognize the central role and responsibilities of governments in Africa in setting priorities and coordinating country efforts and call upon our partners to support such national ownership. We will mobilize our diplomats and other representatives in each concerned country to work with national leaders and others to intensify cooperative actions, to share relevant information needed to strengthen local capacity and to deliver necessary health services and cost-effective treatments for HIV/AIDS and other infectious diseases. Public awareness We will cooperate to increase public awareness of the scope of the crisis and to propagate effective health and prevention measures. The roles of primary health care services and basic education are crucial, as are information and other disease-targeted campaigns. We call upon political leaders in Africa and elsewhere to encourage information and education campaigns, including on how to prevent mother to child transmission of HIV/AIDS. We welcome the success in some countries where strong leadership, openness to issues and flexible responses come together. Drugs and vaccines Together with developing country partners and with industry, we will strengthen our research and development cooperation in the fight against 05/24/00 WED 13:13 FAX 202 647 9959 EUR ERA STATE 004 these poverty-related diseases. In this respect, we call for enlarged partnerships aimed at speeding up research and development. We will explore new methods of evaluating needed drugs and vaccines, including strengthening capacity and training in those countries most impacted by these diseases. In order to make new drugs, vaccines and other public health intervention methods available faster, we will stimulate increased links between our respective research activities and coordinate research tasks. We will support the introduction of new financial, legal and investment incentives designed to make safe and effective drugs and vaccines more accessible and affordable to countries in need. We will support international coordination initiatives, such as the Global Alliance for Vaccines and Immunization (GAVI), the Multilateral Initiative on Malaria and the EU-ACP West African Vaccine Independence Initiative, which encourage partnerships and international collaboration in the development of affordable drugs and vaccines. Resources The EU and US will seek increased governmental and private resources dedicated to the fight against HIV/AIDS and other diseases, including through multilateral organizations and institutions. We acknowledge and encourage the important role of industry, NGOs and civil society. In the World Bank and other relevant organizations, we will support the setting up of mechanisms such as concessionary loans and debt relief. We will support governments that undertake to improve their heath systems with resources made available under the HIPC debt relief initiative and through the implementation of the Poverty Reduction Strategies developed in consultation with civil society and international donors. We will seek to augment multilateral bank lending for healthcare systems. 05/04/00 THU 16:06 FAX AIDS POLICY 4 001 OFFICE OF NATIONAL AIDS POLICY EXECUTIVE OFFICE OF THE PRESIDENT THE WHITE HOUSE FACSIMILE TRANSMITTAL SHEET TO: FROM: COMPANY: Nora Dempsy Cheryl Bauele DATE- FAX NUMBER: TOTAL NO. OF PACES INCLUDING COVER: 6-9260 PHONE NUMBER: RE: URGENT FOR REVIEW PLEASE COMMENT PLEASE REPLY PLEASE RECYCLE NOTES/COMMENTS: Here it is! 736 Jackson Place Washington, DC 20503 (202) 456-2437 (202) 456-2438 (fax) Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 003. letter Terje Anderson to Henry DuToit [partial] (1 page) ca. 05/2000 P6/b(6) COLLECTION: Clinton Presidential Records National Security Council African Affairs (Byrne, Cathy/Dempsey, Nora/Battenfield, Patricia) OA/Box Number: [OA/ID 3078] FOLDER TITLE: Dempsey - AIDS [1] 2007-1550-F ke2005 RESTRICTION CODES Presidential Records Act - [44 U.S.C. 2204(a)] Freedom of Information Act - [5 U.S.C. 552(b)] P1 National Security Classified Information [(a)(1) of the PRA] b(1) National security classified information [(b)(1) of the FOIA] P2 Relating to the appointment to Federal office [(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) of the PRA] an agency [(b)(2) of the FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) of the FOIA] financial information [(a)(4) of the PRA] b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information [(b)(4) of the FOIA] and his advisors, or between such advisors [a)(5) of the PRA] b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) of the FOIA] personal privacy [(a)(6) of the PRA] b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) of the FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells [(b)(9) of the FOIA] RR. Document will be reviewed upon request. 05/04/00 THU 16:06 FAX AIDS POLICY 002 May-04-00 09:42am From- T-078 P.01/02 F-809 Mr. Henry DuToit Embassy of South Africa 3051 Massachusetts Avenue, NW Washington, DC 20008 202-232-0910 the National Association of People AIDS Dear Mr. DuToit, I am pleased to learn of President Mbeki's plans to convene an international panel 1413 K Street, NW of experts to advise the Government of South Africa on HIV/AIDS issues. As a Washington, DC person living with HIV who serves in this country on President Clinton's 20005-3442 Presidential Advisory Council on HIV/AIDS, I know the potential value of such 202-898-0414 an advisory body. FAX 202-898-0435 www.napwg.org Various lists of names of people to serve on this panel have been in circulation, bringing together a variety of backgrounds and viewpoints. I would like to offer an unsolicited list of other names for your consideration should your government have the opportunity to appoint additional people to this important panel. 1.) Dr. Marsha Lillie-Blanton, who serves as Vice-President for Health Policy at the Kaiser Family Foundation. Dr. Lillie-Blanton has extensive experience in issues of health care financing and health care delivery systems, with a particular focus on the needs of minority populations. She can be reached at 650-854-9400. P6/(b)(6) [003] 3.) Dr. Mark Smith, President of the California Health Foundation, is an African-American physician with more than a decade of experience in HIV/AIDS clinical, policy and funding issues. He can be reached at 510-238-1040. P6/(b)(6) 5.) Finally, I am disappointed that none of the lists I have seen have included the names of any people known to be living with HIV/AIDS. In this country, we have benefitted greatly from including infected people in all levels of decision- making around HIV/AIDS, ensuring that decisions are relevant to the lives of those most impacted by this epidemic. I strongly urge your government to identify 05/04/00 THU 16:06 FAX AIDS POLICY 003 May-04-00 09:42am From- T-078 P.02/02 F-809 one or more South Africans living with HIV/AIDS to include on this important panel. Should you seek assistance in that matter, I would be very happy to help in any way I or my organization can. Thank you for you attention On this important matter. Please do not hesitate to contact me directly if I can be of any assistance. Most sincerely, Terje Anderson Executive Director 05/04/00 THU 16:07 FAX AIDS POLICY 5 004 May-04-00 01:56pm From-NCHSTP +4046398600 T-278 P.02/10 F-294 Department of Health Memo #2 To: Dr Helene Gayle From: Ray Mabope CC: 091-404-639-8600 Date: 04/26/00 Re: International AIDS Panel Dear Helene Gayle Find attached herewith a letter of Invitation from the President of South africa, Mr Thabe Mbeki, in which he invites you TO participate in the International AIDS Panel. I would appreciate it very much if you could confirm with me your acceptance of the invitation as soon as passible. Yours Truly, Has RAY MABOPE Chief Director: National Health Systems, National Department of Health Tel +27-12-312-0497 Mabite 972-82-458-8263 Fax +27-12-325-8721 Exsect-ese E-mail: [email protected] . Page 9 05/04/00 THU 16:07 FAX AIDS POLICY 005 May-04-00 01:56pm From-NCHSTP +4046398600 T-278 P.03/10 F-284 April 24, 2000. Sir/Madam, In its report on the "Global Situation of the HIV/AIDS pandemic, end 1999", the WHO says: be of the 5.6 million people infected with HIV in 1999, 3.8 million live in Sub-Saharan Africa, the hardest-hit region. There were an estimated 2.2 million HIV/AIDS deaths in the region during 1999 (85% of the global total), even though only one-tenth of the world population lives there. In addition, there are now more women than men among the 22.3 million adults and 1 million children estimated to be living with HIV/AIDS in sub- Saharan Africa." Clearly, this represents a major catastrophe for our country as well, as it falls within what the WHO (and UNAIDS) describe as the hardest-hit region. Because of this, our Government took the decision that it was necessary to respond to this simation in an urgent and comprehensive manner, using all means at its disposal. As we were investigating these means, while simultaneously working to implement measures already advised by the WHO and UNAIDS, we became aware that there was a considerable amount of disagreement among scientists about a whole variety of matters relating to HIV/AIDS. 1 05/04/00 THU 16:07 FAX AIDS POLICY 006 May-04-00 01:56pm From-NCHSTP +4046398600 T-27B P.04/10 F-284 The issues at stake are directly relevant to the comprehensive response we seek to make. At the centre of these are such questions as: what causes the immune deficiency which leads to death from AIDS? what is the most efficacious response to this cause or causes? why is HIV/AIDS in sub-Saharan Africa heterosexually transmitted while in the Western world it is said to be largely homosexually transmitted? and, what is the efficacy of anti-retroviral drugs against HIV/AIDS? It seemed to us that we need ID be as certain as we can be with regard to these and other matters, bearing in mind the level and extent of scientific knowledge at this point in time. We believe that this is a critical and necessary condition for us to undertake the urgent and comprehensive response of which we have spoken. We are also aware of the fact that many others on our Continent are also preoccupied with this issue in the same way that we are, precisely because together, we are concerned that we should save the lives of the millions of Africans who, it is said, are destined to die. For these reasons, we have taken the initiative to convene an international panel of scientists openly to discuss all the matters in contention. We have tried to ensure that this panel includes all points of view in the debate and is constituted of eminent world scientists. Accordingly, on behalf of the South African Government, I am privileged to extend an invitation to you to participate in this panel. It is proposed that the first interaction of the panel should take place in South Africa on the 6-7 May, 2000. I also attach a list of other people who have been invited to join the. panel, the majority of whom have already confirmed their availability. 2 05/04/00 THU 16:08 FAX AIDS POLICY 007 May-04-00 01:57pm From-NCHSTP +4046398600 T-278 P.05/10 F-284 The South African Government will, of course, meet your travelling, hotel and other costs arising from your participation in the panel. Our Director General of Health will contact you immediately with regard to all other matters relevant to the work of the panel, including the terms of reference, proposed procedures during the discussions etc. I am greatly encouraged that we can COUNT on your support in the common fight to save particularly our Continent and its peoples from the scourge of AIDS. Yours sincerely, THABO MBEKI. President Republic of South Africa. 3 05/04/00 THU 16:08 FAX AIDS POLICY 008 May-04-00 01:58pm From-NCHSTP +4046398600 T-278 P.06/10 F-294 Dear Esteemed Panelist RE: SOUTH AFRICAN PRESIDETIAL AIDS ADVISORY PANEL 1. WELCOME 1.1 We wish to express our heartfelt gratitude to you for accepting the invitation to participate in the above panel and attending The inaugural meeting of the panel in South Africa on 6 & 7 May, 2000. 1.2 We wish you 0 pleasant journey TO the sunny skies of South Africa. We are looking forward TO benefit from your contributions during The panel discussion. 1.3 In your letter of invitation the President indicated that you shall receive a letter from me covering some matters relevant to the work of the panel. This communication addresses some of these areas. 2. PANELISTS Herewith is the list of participants who have confirmed their participation at the meeting of 6 & 7 May 2000, as of today. We continue to receive other confirmation. 2.1 Prof Salim Abdool-Karim 2.2 Dr Bialy, Harvey 2.3 Dr deHarven, Etienne 2.4 Prof Duesberg. Peter 2.5 Dr Fiala, Christian 2.6 Dr Gayle, Helene 2.7 Dr Giraldo. Roberto 2.8 Dr Herxheimer, Andrew 2.9 Dr Koehnlein, Klaus 2.10 Dr Kothari, R 2.11 Dr Lane, Clifford 2.12 Prof Makgoba. Malegapuru W 2.13 Dr Mhtongo, Sam 2.14 Prof Montagnier, Luc 1 05/04/00 THU 16:08 FAX AIDS POLICY 009 May-04-00 01:58pm From-NCHSTP +4046398600 T-278 P.07/10 F-294 2.15 Dr Mugerwa, Roy 2.16 Dr Owen, Stephen [Facilitator-in-Chief] 2.17 Dr Paranjape 2.18 Dr Perez, George 2.19 Prof Prozesky, Wally 2.20 Prof Rasnick, David 2.21 Dr Scondras, Dave 2.22 Dr Sonnabend, Joseph 2.23 Dr Stein, Zena 2.24 Dr Stewart, Gordon 2.25 Prof Ephraim Mokgokong [Facilitator] 2.26 Dr Zuniga, Jose M 3. TERMS OF REFERENCE The terms of reference broadly are: 3.1 Evidence of viral aetiology of HIV and related concerns about pathogenesis and diagnosis. This naturally will deal with such questions as: A. What causes the immune deficiency which leads to death from AIDS? b. What is the most efficacious response to this cause or causes? C. Why is HIV/AIDS in Sub-Saharan Africa heterosexually transmitted while in the western world it is said to be largely homosexually transmitted? 3.2 What is the role of therapeutic interventions in the context of developing countries? This should cover such areas as: a. What therapeutic interventions are appropriate in developing countries: In patients with AIDS In HIV positive patients In the prevention of mother to child transmission 2 05/04/00 THU 16:08 FAX AIDS POLICY 010 May-04-00 01:58pm From -NCHSTP +4046398600 T-278 P.08/10 F-294 In The prevention of HIV transmission following occupational injury In preventing HIV transmission following rape. 3.3 Therapeutic prevention of HIV/AIDS. a. The discussions above should be underpinned by considerations of The social and economic context, especially poverty and other prevalent co-existing diseases and The infrastructural realities of developing countries. 4. FORMAT OF THE MEETING 4.1 The meeting will commence at 08:00 on Saturday. 6 May 2000, and end on Sunday, 7 May 2000, at approximately 16:00. 4.2 The South African government will welcome the participants. 4.3 The Facilitator will take over and provide each participant an opportunity to make 0 brief input. This will be followed by an extraction and distillation of the issues to be discussed by the panel and a proposal on the work programme for the two days from the facilitators. 4.4 Prof Stephen Owen has been nominated as The facilitator-in- Chief. Two co-Facilitators will assist him. A secretariat will be in attendance to assist The facilitators and participants to document The proceedings of the meeting. 4.5 A draft summary of proceedings will be presented at the end of the meeting on Sunday. This will be followed by 0 derailed summary that will inform an internet discussion that will follow over 0 period of 6 weeks thereafter. 4.6 You will also be invited to recommend names of people to participate in the closed Internet discussion. 3 05/04/00 THU 16:09 FAX AIDS POLICY 011 May-04-00 01:59pm From-NCHSTP +4046398500 T-278 P.DB/10 F-284 4.7 Finally, there will be a concluding meeting in South Africa in late June/early July [dates still TO be negotiated]. 5. COMMUNICATION 5.1 It is proposed that a media conference be held by The facilitators at the end of the meeting to communicate the progress made by the panel during the two-day meeting. 5.2 The South African Broadcasting Corporation [SABC] has approached the South African government with o view to do a live broadcast of the proceedings of the meeting. The government has indicated to The SABC that it would seek the permission of the panelists before acceding to their request. You are therefore requested to indicate your opinion on this matter by Tuesday, 2 May 2000, and TO provide guidance regarding your preference. If, however, it is the view of some panelists that The media should not do a live broadcast of the proceeding, the request from the South African Broadcasting Corporation will be Turned down without further discussion. 6. TRAVEL ARRANGEMENTS 6.1 We propose that panelists should plan to be in South Africa on Friday. 5th May, in order to start at 08:00 on Saturday. The South African government will pay or reimburse participants for 0 return business class flight to and from Johannesburg. 6.2 We have appointed Reynolds Travel as our travel agent TO facilitate The flight arrangements and airport/hotel transfers for all The panelists. Please feel free to reach Mary Reynolds directly at [email protected] We have furnished Reynolds Travel with a list of all the participants who will be attending the meeting of the 6 & 7 May. 6.3 For those who need to be reimbursed for airline tickets already purchased, please contact Mrs Hannekie Botha OT 4 05/04/00 THU 16:09 FAX AIDS POLICY 012 May-04-00 01:58pm From-NCHSTP +4045398600 T-278 P.10/10 F-294 [email protected] and she will make arrangements for the monies to be paid into your credit card. 7. ACCOMMODATION 7.1 We have booked all the participants at the Sheraton Hotel in Pretoria. 7.2 Reynolds Travel is also responsible for booking your hotel accommodation. They will provide you with the relevant information in This regard as soon as possible. 8. TRANSPORT 8.1 Reynolds Travel will also meet you at the airport and transport you TO the Sheraton Hotel in Pretoria. Pretoria is approximately 50 kilometers away from the Johannesburg International Airport. 9. MEETING VENUE 9.1 The meeting will be held at the Sheraton Hotel in Pretoria where you will also be accommodated. Please let us know beforehand whether you will need any special equipment or facilities during The meeting. 10. HONORARIUM 10.1 An honorarium of R2,500.00 for each of the 2 days will be offered TO each of the panelists. Yours Sincerely DR AYANDA NTSALUBA Director General Department of Health Republic of South Africa P.S. Please direct all inquiries TO Mr Ray Mabope END! 5 AIDS Threat Designation Defended http://dailynews.yahoo.com/h/ap/20000430/pl/aids_threat_3.html YAHOO! NEWS Home - Yahoo! - My Yahoo! - News Alerts - Help AP Associ Press 9.9% Fixed Rate CapitalOne® VISA PLATINUM Click here to apply NOT JUST ANOTHER PRETTY CARD Nora Apply Now-VISA-Instant Decision! 5/1 Home Top Stories Business Tech Politics World Local Entertainment Sports Science Health Politics Headlines Add to My Yahoo! Sunday April 30 8:10 PM ET VOTENET AIDS Threat Designation Defended Click here for political contributions by neighborhood (enter ZIP). WASHINGTON (AP) - Clinton administration officials Sunday defended their decision to classify AIDS as a threat to national security - a designation aimed at garnering more attention and funding toward Full Coverage combating the disease worldwide. See a Yahoo! special report on AIDS - HIV News Sandy Thurman, director of the White House Office of National AIDS Related News Stories Policy, said AIDS has become such an epidemic that, in years to come, U.S. Brands AIDS National it threatens to destabilize nations and the economies of whole Security Threat - Reuters (Apr continents. 30, 2000) U.S. Reportedly Calls AIDS '`We have to respond to this because we've never seen a crisis like HIV National Security Threat - and AIDS globally," Thurman said. "We're beginning to understand Reuters (Apr 30, 2000) that this epidemic, not only has health implications, but has AIDS Is Declared Threat to implications as a fundamental development issue, an economic issue Security - Washington Post (Apr 30, 2000) and a stability and security issue." AIDS deaths rise 15 percent in Senate Majority Leader Trent Lott, in an Miami-Dade County - Miami Speak your mind Herald (Apr 27, 2000) appearance earlier in the day, said he does not believe AIDS is a national security Lost years in the life of AIDS let Discuss this story with polio vaccine off the hook - The other people. threat. [Start a Conversation] Telegraph (Apr 26, 2000) (Requires Yahoo! Messenger) More In Full Coverage ``I guess this is just the president trying to make an appeal to, you know, certain Related Web Sites groups," Lott, R-Miss., told ``Fox News Sunday." ``I don't view that as World AIDS Campaign: Listen, a national security threat, not to our national security interests, no." Learn, Live! - focusing on the AIDS and how it affects Children and Young People. Find out what Thurman countered that a report earlier this year from the National you can do, and get statistics and Intelligence Council indicates that the disease is ``sweeping the globe," background documents. From posing a crisis in Africa today and threatening India and newly UNAIDS. independent nations of the former Soviet Union in the future. AIDS Education Global Information System (AEGIS) - ``With the logistical expertise that the national security community includes a searchable news brings, with the diplomatic expertise that is necessary to sort of pave archive, prevention information, a law library, information on the road for leaders around the world to respond to this epidemic, this treatment options and living with gives us a whole new ability to respond to AIDS like we would respond HIV. to any other international threat," Thurman said. AIDS101.com - with news, basic information, origins, social The White House, in raising the status of AIDS, has creating an impact of the disease, and interagency working group. The Clinton administration has designated biology. 1 of 3 5/1/2000 7:49 AM AIDS Threat Designation Defended http://dailynews.yahoo.com/h/ap/2000430/pl/aids_threat_3.hml interagency working group. The Clinton administration has designated biology. about $325 million to fighting the disease worldwide this year, most of HIV/AIDS Treatment it going to Africa, and the president wants an additional $100 million Information Service (ATIS) - information on federally for fiscal 2001, Thurman said. approved treatments for HIV infection, treatment-related She said a large focus of the effort would be on finding a vaccine. publications, and links to other treatment-related sites. E-mail this story Printer-friendly format Johns Hopkins AIDS Service - with publications, resources, prevention and treatment Earlier Stories information. More In Full Coverage Report: AIDS Designated a Threat (April 30) Opinion & Editorials Older age is no protection against AIDS - Detroit Free Press (Apr 21, 2000) Arresting AIDS -- Coburn's Idea: Focus First on HIV - Oklahoman (Mar 30, 2000) Rape victims - Dallas Morning News (Mar 7, 2000) Magazine Articles Flirting With PseudoScience - Village Voice (Mar 14, 2000) Foo Fighters, HIV Deniers - Mother Jones (Feb 25, 2000) When Did AIDS Begin? - Time (Feb 14, 2000) Audio Death of Singer Sparks Controversy Over AIDS and Privacy - NPR (Mar 1, 2000) More In Full Coverage Video CDC: Minorities represent more than half of new AIDS cases among gay men - CNN (Jan 14, 2000) "Some cultural attitudes have to change" - BBC (Dec 1, 1999) Related Full Coverage AIDS Research Update Yahoo! Categories AIDS Memorials AIDS/HIV AIDS/HIV Alternative Views More In Full Coverage Search Advanced Search: Stories Photos Full Coverage 2 of 3 5/1/2000 7:49 AM April 27, 2000 GLOBAL AIDS CRISIS Background: The human toll of AIDS is staggering. Fifty million people worldwide have been infected with the HIV virus; 33.6 million are now living with HIV/AIDS, and annual AIDS- related fatalities hit a record 2.6 million last year. Ninety- five percent of all cases are in the developing world. AIDS is now the leading cause of death in Africa and fourth in the world. In at least five African countries, over 20 percent of adults are HIV-positive. And the highest rates of new infections are often among young women who will soon be mothers. On January 10, the United Nations Security Council held a daylong session on the global threat posed by HIV/AIDS. This event was the first time the Security Council considered a health issue. The session reinforced what we have stated repeatedly, that AIDS is much more than a health or humanitarian issue -- it is a development issue, a trade issue, and a key stability and security issue. The U.S. government remains the world leader in responding to the global pandemic of AIDS. Current USG activities emphasize enhanced financial and political commitment, primary prevention, improving community and home based care and treatment, caring for children affected by HIV/AIDS, health infrastructure development, biomedical and behavioral research and training, and multisectoral efforts from the grass roots to the international level that reduce the impact of AIDS. Challenges for the next ten Months: Dramatically increase international spending for HIV/AIDS prevention and patient care and treatment. The average sub- Saharan African country has only $5-20 million from all sources to spend on AIDS prevention and care - a ludicrously insufficient amount. - We intend to push for new initiatives to increase the accessibility of drugs to those in Africa who need them most, and to find a way to help countries decrease mother- to-child transmission of AIDS. Enhance political commitment by national governments to combat HIV/AIDS as a national and international priority, including 2 mobilizing and leveraging increased internal national budget resources. - The President's joint statement with India on HIV/AIDS, and India's recent IDA loan to fund AIDS activities are good examples of the leadership needed. - We will be joining the SADC FILL IN PLEASE Leveraging an enhanced response from other bilateral donors and multilateral institutions through a U.S.-lead international cooperative effort. At the US-EU Summit next month, we will be joining the EU in promoting new initiatives to increase activities to combat the epidemic, especially in Africa. - The Japanese have indicated that HIV/AIDS will be a major agenda item on the G-8 meeting in Okinawa in July. The U.S. will be joining our G-8 partners in pushing for increased international funding of AIDS efforts. Leveraging an enhanced response from the private sector in the United States, including corporations, foundations, religious institutions and non-governmental organizations. Questions and Answers Did South African President Mbeki send a letter to the President regarding the AIDS epidemic in his country? What did he say? Do we think that he is espousing a dangerous course of action that has been scientifically discredited? Has the President responded? South African President Thabo Mbeki has written to the President. The President has not yet responded. This was a private communication between two leaders and I don't want to comment specifically on the contents of the letter. There is no question that President Mbeki understands the depth of the health crisis facing much of Africa, including his own country. South Africa is doing a great deal, including appointing a senior government task force, an AIDS council between the public and private sector, and a country-wide education campaign. We recognize that the AIDS epidemic in Africa, including South Africa, is manifesting itself in different ways than it has in the United States. They are doing everything within their capacity to deal with this crisis. They don't have the same health care infrastructure that we do, for example, which means that in addition to what the South African government is 3 already doing, they also need to look at additional approaches relevant to specific conditions in Africa. Do we agree with the views of every expert he's consulted? No, we don't and we have communicated that to the South African government. But we do agree with his premise that more has to be done globally, and more needs to be done in Africa. We have to keep in mind the limited resources Africa has to deal with this. Our estimates are that in some African countries, like Uganda, treating every infected individual would cost more than ten times the national budget. There is no question that AIDS threatens the economic, political and social progress that Africa has made. That's the reason the Vice President and Ambassador Holbrooke put this issue front and center in the United Nations Security Council in January, and why we have an interagency working group studying how we can help Africa confront this major challenge. Is Mbeki coming to the US on an official visit? We have not yet made an official announcement. Will HIV/AIDS be on the agenda? Of course, as will a number of other issues of common concern to the United States and South Africa. How much is the USG spending on AIDS, especially in Africa? Should we be doing more? Since 1986, USAID has dedicated over $1.2 billion to mitigate the epidemic. For FY 2000, Congress appropriated funding for our global AIDS prevention and care program of $225 million - four times as much as the next largest donor. And nearly two thirds will go to Africa. The FY2001 budget request includes an additional $100 million increase in our global AIDS effort (for a total of $325 million, excluding research) which will be targeted to: prevention; basic care and treatment; support for orphans; and health infrastructure development, and implemented by USAID, HHS (CDC), DOL and DOD. In addition, NIH is spending over $1.8 billion annually on AIDS research, with over $200 million each year in the search for a vaccine. Yes, we - and all concerned countries - should be doing more. The USG is now engaged in an interagency process to identify and refine a series of new initiatives and partnerships to deal with the critical issues, especially leadership, public awareness, increasing accessibility to drugs in poor countries, and prevention of mother/child transmission. The President plans to discuss what more the international community can do on this critical issue at the U.S.-EU Summit next month in Lisbon, and with the G-8 in Okinawa. Ongoing discussions with James Wolflensohn at the World Bank indicate that the mulitlateral development banks are willing to make substantial funds available to eligible countries to 4 meet the prevention, treatment and care requirements of eligible countries. This will complement the Cologne debt initiative agreement last year in which, for the first time, we agreed with our G-7 partners to encourage debt relief for the HIPC countries with the funds to be used for social and health programs such as AIDS control.

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Dempsey - AIDS [1]

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